Survival after first esophageal variceal hemorrhage in patients with biliary atresia.
OBJECTIVE
To determine the influence of the new onset of esophageal variceal hemorrhage (EVH) on transplant-free survival in children with biliary atresia and to examine variables that predicted survival after the onset of EVH.


METHODS
Retrospective chart review of 134 patients with biliary atresia who underwent portoenterostomy between 1973 and 1992 at a single institution; 29% had EVH.


RESULTS
The risk of death or need for liver transplantation was 50% at 6 years after the initial episode of EVH. Patients with a serum bilirubin concentration < or =4 mg/dL at the first episode of EVH had transplant-free survival of >80% for 4 years after this episode, those with bilirubin levels >4 to 10 mg/dL had 50% survival at 1 year, and those with bilirubin levels >10 mg/dL had 50% survival at 4 months. The risk of death or transplant for a child with EVH and total serum bilirubin levels >10 mg/dL was 12.0 (95% CI: 6.0, 24.1), 4 to 10 mg/dL was 7.2 (3.1, 16.7), and < or =4 mg/dL was 0.6 (0.1, 3.1) times the risk of a same-aged child who did not have EVH.


CONCLUSIONS
Children with biliary atresia and first EVH episode have a variable prognosis related to total serum bilirubin concentration at the time of the episode.
Miga
D
D
Pediatric Liver Center and Liver Transplantation Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, the Department of Pediatrics, University of Colorado School of Medicine and The Children's Hospital, Denver, Colorado 80218, USA.
Sokol
R J
RJ
Mackenzie
T
T
Narkewicz
M R
MR
Smith
D
D
Karrer
F M
FM
D001656:Biliary Atresia / Q000150:complications / Q000601:surgery*; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D015996:Survival Rate
D001663:Bilirubin