Biliary atresia--a fifteen-year review of clinical and pathologic factors associated with liver transplantation.
OBJECTIVE
The aim of this study was to identify clinical and pathologic factors associated with liver transplantation in infants with biliary atresia initially treated with Kasai hepatic portoenterostomy (KHPE).


METHODS
Institutional Review Board approval was obtained. Records of patients with biliary atresia diagnosed between January 1986 and December 2000 were reviewed. Patients were divided into those who never required transplantation, those who underwent transplant in the first year after KHPE, and those who required transplantation later in childhood. Analysis of variance (ANOVA) compared multiple factors among the 3 groups. Proportional analysis compared those who required transplantation against those who did not. Statistical significance was considered achieved if P was less than.05.


RESULTS
Forty-five patients were identified. Survival after KHPE was 96% (43 of 45). Sixteen (37%) never required transplantation, 13 (30%) underwent transplant within 1 year after KHPE, and 14 (33%) underwent transplant more than 1 year after KHPE. ANOVA comparison showed that the duration of jaundice before KHPE as a predictor for liver transplantation approached significance (P =.082). Proportional analysis found that a longer initial duration of jaundice before KHPE (P =.016) and failure to establish biliary flow (P =.033) were also significant predictive factors. An initial requirement for phototherapy (P =.057) and ductules less than 200 microm in diameter (P =.060) showed a trend toward predictor of liver transplantation.


CONCLUSIONS
A longer duration of jaundice before KHPE, failure to establish bile flow, requirement for phototherapy in the neonatal period, and ductules smaller than 200 microm are associated with liver transplant after KHPE.
Baerg
Joanne
J
Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA 92354, USA.
Zuppan
Craig
C
Klooster
Marquelle
M
D000015:Abnormalities, Multiple / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001652:Bile Ducts / Q000648:ultrastructure; D001656:Biliary Atresia / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001724:Birth Weight; D002761:Cholangitis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007567:Jaundice, Neonatal / Q000209:etiology / Q000628:therapy; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008423:Maternal Age; D010789:Phototherapy; D011171:Portoenterostomy, Hepatic / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome