Management of adult biliary atresia patients: should hard work and pregnancy be discouraged?
OBJECTIVE
The purpose of the paper was to study the potential risk and management of adult biliary atresia (BA) patients.


METHODS
Clinical courses and biochemical data were retrospectively analyzed in 52 BA patients who were operated in our department and are now older than 15 years, with special emphasis on 47 patients who survived beyond the age of 20 years.


RESULTS
Of these 47 patients, 45 (95.7%) are employed, receiving higher education, and/or married. Thirty-three patients showed favorable liver function at the age of 20 years with their native liver. Thereafter, 6 (18.2%) developed liver dysfunction after working hard or pregnancy. In these 6 patients, cholinesterase levels were significantly lower at the age of 20 years than those in the 27 stable patients (239.5 +/- 42.6 vs 285.8 +/- 47.5, P = .0216), whereas no significant difference was found in alanine aminotransferase, aspartate aminotransferase, or total protein levels at the age of 20 years or in any biochemical parameters at the age of 15 years. Of the 14 transplanted patients, 5 who underwent transplantation after the age of 20 years had relatively uneventful courses until the age of 20 years; however, their biochemical data already showed significant deterioration at puberty.


CONCLUSIONS
Social activities and pregnancy should be managed individually according to the risk assessment for potential hepatic failure even in stable adult BA patients. A falling cholinesterase level after the age of 20 years may predict the risk for the late hepatic dysfunction.
Kuroda
Tatsuo
T
Department of Surgery, National Center for Child Health and Development, Tokyo, Japan. kuroda-t@ncchd.go.jp
Saeki
Morihiro
M
Morikawa
Nobuyuki
N
Watanabe
Koji
K
D000293:Adolescent; D000328:Adult; D001656:Biliary Atresia / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008019:Life Style; D008111:Liver Function Tests; D008297:Male; D009043:Motor Activity; D010353:Patient Education as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012308:Risk Management; D012720:Severity of Illness Index; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D014937:Work