title: Impact of Kasai portoenterostomy on liver transplantation outcomes: A retrospective cohort study of 347 children with biliary atresia.
abstract: Biliary atresia (BA) is the main diagnosis leading to liver transplantation (LT) in children. When diagnosed early in life, a Kasai portoenterostomy (Kasai-PE) can prevent or postpone LT. Instances of previous operations can result in difficulties during the LT. We hypothesized that a previous Kasai-PE could affect LT outcomes. A retrospective cohort study of 347 BA patients submitted to LT between 1995 and 2013 at Hospital Sírio-Libanês and A. C. Camargo Cancer Center was conducted. Patients were divided into those with a previous Kasai portoenterostomy early failure (K-EF), Kasai portoenterostomy late failure (K-LF), and those with no Kasai portoenterostomy (No-K). Primary outcomes were patient and graft survival. A total of 94 (27.1%) patients had a K-EF, 115 (33.1%) had a K-LF, and 138 (39.8%) had No-K before LT. Children in the K-LF group were older and had lower Pediatric End-Stage Liver Disease (PELD) scores. Patients in both K-EF and K-LF groups had more post-LT biliary complications. After Cox-multivariate analysis adjusting for confounding factors to determine the influence of Kasai-PE on patient and graft survival, the K-LF group had an 84% less probability of dying and a 55% less chance to undergo retransplantation. The K-LF group had a protective effect on posttransplant patient and graft survival. When properly performed, the Kasai procedure can postpone LT and positively affect outcomes. Having a K-EF and having not performed a Kasai-PE had the same effect in patient and graft survival; however, a previous Kasai-PE can increase post-LT complications as biliary complications and bowel perforations.
authors.affiliation: Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.|Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil.
authors.forename: Joao Seda
authors.initials: JS
authors.lastname: Neto
authors.affiliation: Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.|Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil.
authors.forename: Flávia H
authors.initials: FH
authors.lastname: Feier
authors.affiliation: Teaching and Research Institute, Hospital Sirio-Libanes, São Paulo, São Paulo, Brazil.
authors.forename: Ana Luiza
authors.initials: AL
authors.lastname: Bierrenbach
authors.affiliation: Department of Health, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiás, Brazil.
authors.forename: Cristiana M
authors.initials: CM
authors.lastname: Toscano
authors.affiliation: Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.|Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Fonseca
authors.affiliation: Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.|Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: Pugliese
authors.affiliation: Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.|Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil.
authors.forename: Helry L
authors.initials: HL
authors.lastname: Candido
authors.affiliation: Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.|Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil.
authors.forename: Marcel R
authors.initials: MR
authors.lastname: Benavides
authors.affiliation: Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.|Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil.
authors.forename: Gilda
authors.initials: G
authors.lastname: Porta
authors.affiliation: Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Chapchap
mesh_terms: D001656:Biliary Atresia / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000209:etiology; D016031:Liver Transplantation; D008297:Male; D011171:Portoenterostomy, Hepatic; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome