title: The most reliable early predictors of outcome in patients with biliary atresia after Kasai's operation.
abstract: OBJECTIVE
  The purpose of this study was to determine reliable predictors of outcome of biliary atresia (BA) after Kasai's operation.
  
  
  METHODS
  Fifty-four BA cases that underwent Kasai's operation at our institution over two decades were reviewed. The cases were divided into two groups: Group I: cases that required liver transplantation or died (n=30) and Group II: cases alive with the native liver. Serum levels of total bilirubin (TB), direct bilirubin (DB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) were measured sequentially after surgery. For cut-off determination, receiver operating characteristic (ROC) analysis was employed.
  
  
  RESULTS
  Serum TB, DB, AST, and ALT in Group I were significantly higher than those in Group II at 1, 2, and 3 months after surgery (p<.05). The most reliable cut-offs determined by ROC analysis were DB of 0.7 mg/dl at 2 months (sensitivity; 93%, specificity; 75%) and AST of 94 IU/L at 2 months (sensitivity; 87%, specificity; 71%). The 54 cases were re-divided into three groups according to the cut-off values: group G (good) with DB and AST<cut-offs (n=16; Group I:II=1:15), group M (moderate) with DB or AST>cut-offs (n=9; Group I:II=4:5), and group P (poor) with DB and AST ≥ cut-offs (n=29; Group I:II=25:4). The 15-year survival rate in groups G, M, and P was 94%, 44%, and 22%, respectively (p<.001).
  
  
  CONCLUSIONS
  The combination of serum DB and AST at 2 months after Kasai's operation is a reliable predictor of long-term BA outcome.
authors: Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho Izumi, Osaka, 594-1101, Japan. Electronic address: tgoda@mch.pref.osaka.jp.
authors: Taro
authors: T
authors: Goda
authors: Hisayoshi
authors: H
authors: Kawahara
authors: Akio
authors: A
authors: Kubota
authors: Katsuhisa
authors: K
authors: Hirano
authors: Satoshi
authors: S
authors: Umeda
authors: Gakuto
authors: G
authors: Tani
authors: Tomohiro
authors: T
authors: Ishii
authors: Yuko
authors: Y
authors: Tazuke
authors: Akihiro
authors: A
authors: Yoneda
authors: Yuri
authors: Y
authors: Etani
authors: Shinobu
authors: S
authors: Ida
mesh_terms: D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D001656:Biliary Atresia / Q000097:blood / Q000401:mortality / Q000601:surgery*; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D003661:Decision Support Techniques; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008111:Liver Function Tests; D016031:Liver Transplantation; D011171:Portoenterostomy, Hepatic; D012372:ROC Curve; D016896:Treatment Outcome; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin
keywords: AST; Biliary atresia; Direct bilirubin; Predictor; Prognosis