Long-term follow-up for anicteric survival with native liver after redo Kasai: a first report.
OBJECTIVE
We present a first report of the long-term follow-up of biliary atresia (BA) patients who became anicteric with the native liver (ANL; total bilirubin <1.5mg/dL) after redo-Kasai.


METHODS
Forty-six redo-Kasai cases (1984-2015) were the subjects for this study. ANL ratios were determined using the Kaplan-Meier estimate.


RESULTS
BA type was I (n=3), II (n=1), and III (n=42). Mean ages (initial/redo) at Kasai were 60.3/231.9days, respectively. Jaundice persisted after the initial Kasai in 24/46 cases while 22 had recurrence of jaundice after initially becoming anicteric. After redo, 5/24 of the persistent jaundice cases and 14/22 of the initially anicteric cases became anicteric (p<.05). Of these 19, 7 (one type I, six type III) are currently ANL while the remaining 12 had LTx or died. Morbidity/Complications documented in the 7 post-redo ANL cases after a mean follow-up of 16.7years (range: 10.0-31.1) included 4 episodes of cholangitis, 3 episodes of portal hypertension, 4 episodes of esophageal varices, 3 episodes of splenomegaly, one splenectomy, and 4 episodes of thrombocytopenia.


CONCLUSIONS
Ours is the first long-term follow-up study of redo-Kasai cases. We found that the ANL ratio after redo-Kasai was low at 7/46 (15.2%) and that ANL were prone to multiple morbidity.


METHODS
Retrospective comparative study, level III.
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: hinakamu@juntendo.ac.jp.
Hiroki
H
Nakamura
Department of Pediatric Surgery, Kagoshima University, Kagoshima, Japan.
Takafumi
T
Kawano
Department of Pediatric Surgery, Nagano Children's Hospital, Nagano, Japan.
Katsumi
K
Yoshizawa
Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
Hideaki
H
Nakajima
Department of Pediatric Surgery, Ibaraki Children's Hospital, Ibaraki, Japan.
Kazuto
K
Suda
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Hiroyuki
H
Koga
Department of Pediatric Surgery, Kagoshima University, Kagoshima, Japan.
Kazuhiko
K
Nakame
Department of Pediatric Surgery, Kagoshima University, Kagoshima, Japan.
Satoshi
S
Ieiri
Department of Pediatric Surgery, Nagano Children's Hospital, Nagano, Japan.
Shigeru
S
Takamizawa
Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
Naoto
N
Urushihara
Department of Pediatric Surgery, Ibaraki Children's Hospital, Ibaraki, Japan.
Toshihiro
T
Yanai
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Atsuyuki
A
Yamataka
D001656:Biliary Atresia / Q000401:mortality / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
Biliary atresia; Morbidity; Native liver; Redo-Kasai