A scoring system to predict the need for liver transplantation for biliary atresia after Kasai portoenterostomy.
A retrospective analysis was performed of the records of 133 patients with extrahepatic biliary atresia (EHBA) who had undergone a Kasai portoenterostomy. The patients were divided into a non-transplantation group who survived but did not receive liver transplantation after the procedure and a failure group of those who died or received liver transplantation. A score was calculated that assessed nine factors, including laboratory values and complications. The data were assessed at the time complications occurred. The scores were analysed by a trend analysis to see if serial scores predicted the evolution of liver disease. A receiver operating characteristic (ROC) curve was plotted to assess the optimal cut-point for the scoring system. There were 98 patients in the non-transplantation group and 35 in the failure group. The latter group had significantly higher post-operative bilirubin (9.3+/-7.2 mg/dl versus 3.5+/-3.1 mg/dl), ALT (136+/-89 U/l versus 92+/-88 U/l), prothrombin time, and incidence of cirrhosis, ascites, oesophageal varices, portal hypertension, cholangitis and sepsis than the non-transplantation group (P<0.05). A score of > or =8 had a high sensitivity (96.9%) and specificity (89.5%) for predicting the need for liver transplant.


CONCLUSIONS
Based on easily available clinical information, our scoring system can predict which patients with biliary atresia who have already undergone a Kasai procedure should be considered for liver transplantation.
Jiang
Chuen-Bin
CB
Department of Paediatrics, Mackay Memorial Hospital, 92, Section 2 Chung San North Road, 104 Taipei, Taiwan.
Lee
Hung-Chang
HC
Yeung
Chun-Yan
CY
Sheu
Jin-Cherng
JC
Chang
Pei-Yeh
PY
Wang
Nien-Lu
NL
Yeh
Ching-Yin
CY
D001656:Biliary Atresia / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D001663:Bilirubin / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D002761:Cholangitis / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008099:Liver / Q000378:metabolism / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000209:etiology; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D011171:Portoenterostomy, Hepatic; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D011517:Prothrombin Time; D012086:Reoperation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013624:Taiwan; D016896:Treatment Outcome
D015415:Biomarkers; D001663:Bilirubin