Biliary atresia: the King's College Hospital experience (1974-1995)
The survival experience of 338 infants born with biliary atresia between January 1973 and December 1995 was analyzed. All the infants had their initial surgery at a single UK centre. These infants were divided into three groups based on year of birth; group 1 (1970s, n = 38); group 2 (1980s, n = 182), and group 3 (1990s, n = 118). The data from group 1 were incomplete and selected, and comparisons with the remaining groups were therefore restricted. However, all infants who had been treated since 1980 underwent portoenterostomy or hepaticojejunostomy and were included.


RESULTS
In the whole cohort there were 89 deaths (26%), 79 children (23%) who underwent liver transplantation and 170 children (50%) who were alive at last follow-up. The 5- and 10-year actuarial survival for group 2 was 50% and 41%, respectively and the 5-year actuarial survival for group 3 was 60%. Overall, 57 children have survived to 10 years after surgery for biliary atresia. There has been a progressive fall in the age at surgery from a median of 77 days in group 1, through 69 days in group 2 to 56 days in group 3 (P < .0001). However, there was no significant difference in outcome to 5 years between the age cohorts (< 40 days, 41 to 60 days, 61 to 99 days, and > or = 100 days; P > .1) for the infants treated since 1980 (n = 200).


CONCLUSIONS
Portoenterostomy is an effective long-term procedure for biliary atresia in about 40% to 50% of infants. The remaining 50% to 60% will require transplantation mostly within 2 years of age, although there is also a continuing need beyond 5 and 10 years. The age at surgery has limited usefulness as a predictor of survival after portoenterostomy and certainly should not be used to dictate primary treatment.
Davenport
M
M
Department of Paediatric Surgery, King's College Hospital, London, England.
Kerkar
N
N
Mieli-Vergani
G
G
Mowat
A P
AP
Howard
E R
ER
D000206:Actuarial Analysis; D000367:Age Factors; D001656:Biliary Atresia / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000009:adverse effects; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom