title: Long-term follow-up study of patients with cholangitis after successful Kasai operation in biliary atresia: selection of recipients for liver transplantation.
abstract: Since the introduction of cyclosporine A, liver transplantation has become accepted as the therapy for end-stage liver disease. However, there are no definite criteria for liver replacement in biliary atresia. We investigated (a) the survival rate after hepatic portoenterostomy (n = 131), (b) liver function tests in fatal cases after an initially successful hepatic portoenterostomy (n = 9), and (c) liver function tests in the patients with episodes of cholangitis after a successful surgical treatment (n = 8). Patients with persisting jaundice after the surgery cannot be expected to survive long, and therefore they definitely should undergo liver transplantation. When total bilirubin concentration was above 10 mg/dl in patients with cholangitis after a successful operation, conservative therapy had almost no effect. Therefore, patients with total bilirubin levels above 10 mg/dl should be considered for liver transplantation. Of the liver function tests, only total bilirubin was reliable as a marker for hepatic failure in the end stage of biliary atresia. Prolongation of thrombo test and episodes of gastrointestinal bleeding also were used in selection of patients for liver replacement.
authors.affiliation: Second Department of Surgery, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Ohkohchi
authors.forename: T
authors.initials: T
authors.lastname: Chiba
authors.forename: R
authors.initials: R
authors.lastname: Ohi
authors.forename: S
authors.initials: S
authors.lastname: Mori
mesh_terms: D001656:Biliary Atresia / Q000401:mortality / Q000601:surgery*; D002761:Cholangitis / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D015996:Survival Rate