title: Grade IV fibrosis interferes in biliary drainage after Kasai procedure.
abstract: OBJECTIVE
  Biliary atresia (BA) is the most common cause of liver transplantation in children. The earlier the treatment is done, the better the prognosis. The aim is to evaluate the impact of late diagnosis in children with BA, including the histopathological findings and success rate of biliary drainage in patients submitted to hepatic portoenterostomy (HPE).
  
  
  METHODS
  A retrospective study of cases of BA in the Department of Pediatric Surgery, Federal University of São Paulo (UNIFESP) between 1998-2011. We found 63 cases of BA; of these, 42 underwent HPE and 21 were referred for liver transplantation. Clinic and pathologic data were evaluated.
  
  
  RESULTS
  The HPE was performed with a mean age of 86.5 days, with 16.6% having the operation at 60 days or earlier; 59.2% between 61 and 90 days; and 23.8% after 90 days. Successful biliary drainage occurred in 31% of surgeries, Mean days when HPE drained was 69.1 days, and 94.3 days when the surgery did not drain (P = .05). All patients who were successfully drained, did not have grade IV fibrosis on histology. In cases in which surgery was performed after 60 days that had not drained, 25% had grade IV fibrosis on biopsy (P = .0469).
  
  
  CONCLUSIONS
  The age of HPE relates to better prognosis of the disease. It was found that the rate of grade IV fibrosis is higher in no drainage patients. All patients with grade IV fibrosis had no biliary drainage.
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
authors.forename: A A
authors.initials: AA
authors.lastname: Salzedas-Netto
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
authors.forename: E
authors.initials: E
authors.lastname: Chinen
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
authors.forename: D F
authors.initials: DF
authors.lastname: de Oliveira
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
authors.forename: A F
authors.initials: AF
authors.lastname: Pasquetti
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
authors.forename: R A
authors.initials: RA
authors.lastname: Azevedo
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
authors.forename: F F
authors.initials: FF
authors.lastname: da Silva Patricio
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
authors.forename: E K
authors.initials: EK
authors.lastname: Cury
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
authors.forename: A M
authors.initials: AM
authors.lastname: Gonzalez
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
authors.forename: F P P
authors.initials: FP
authors.lastname: Vicentine
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
authors.forename: J L
authors.initials: JL
authors.lastname: Martins
mesh_terms: D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D001656:Biliary Atresia / Q000150:complications / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D001706:Biopsy; D057210:Delayed Diagnosis / Q000009:adverse effects*; D018450:Disease Progression; D004322:Drainage / Q000379:methods; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011171:Portoenterostomy, Hepatic; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome