title: Scottish outcomes for extra hepatic biliary atresia post-rationalisation of services.
abstract: OBJECTIVE
  To evaluate the outcome of Scottish children with extra hepatic biliary atresia (EHBA) since rationalisation of Kasai services to three English centres in 2002 (The 'Group A' centres).
  
  
  METHODS
  All Scottish children with EHBA diagnosed between 2002 and 2009 were identified via the Scottish Society of Paediatric Gastroenterology, Hepatology and Nutrition (SSPGHAN) clinicians. A case-note review was conducted with demographics, presentation and outcome data recorded. These data were compared with historical Scottish data and data published previously by the supraregional liver units.
  
  
  RESULTS
  25 patients were identified, of whom 22 were referred for Kasai in the group A centres, and of whom 19 had a Kasai. 2 year transplant-free survival (TFS) was significantly lower in the SSPGHAN 2002-2009 group than the group A centres in (1) (6/18 (33%) vs 36/57 (63%), p=0.023).
  
  
  CONCLUSIONS
  These postrationalisation data are disappointing. The emphasis for care will now focus on improved communication between, primary care, general paediatricians and surgical centres through regional and national managed clinical networks, aiming to improve future outcomes for Scottish children with BA.
authors: Department of Paediatric Gastroenterology abd Nutrition, Royal Hospital for Sick Children, Glasgow G3 8SJ, UK. andrew.barclay@ggc.scot.nhs.uk
authors: Rachel
authors: R
authors: Tayler
authors: Andrew R
authors: AR
authors: Barclay
authors: Pam
authors: P
authors: Rogers
authors: Karen
authors: K
authors: Mcintyre
authors: Richard K
authors: RK
authors: Russell
authors: David
authors: D
authors: Devadason
authors: W Mike
authors: WM
authors: Bisset
authors: Simon C
authors: SC
authors: Ling
authors: Paraic
authors: P
authors: McGrogan
mesh_terms: D000367:Age Factors; D001656:Biliary Atresia / Q000453:epidemiology / Q000601:surgery*; D004739:England; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011171:Portoenterostomy, Hepatic / Q000592:standards*; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data; D012041:Regional Medical Programs / Q000458:organization & administration / Q000592:standards; D012606:Scotland / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome