title: Biliary atresia in Vietnam: Management and the burden of disease.
abstract: Biliary atresia is an idiopathic, neonatal liver disease of the bile ducts. The natural evolution of biliary atresia is known in developed countries. This study describes the clinical course of biliary atresia in Vietnam, a developing country.
  
  
  
  Chart reviews were undertaken of patients treated with or without the Kasai procedure between January 2010 and July 2013 at a children's hospital in Vietnam.
  
  
  
  Of 287 children with biliary atresia, 149 (52%) were treated without the Kasai procedure and 138 (48%) were treated with the Kasai procedure. Median age at diagnosis was 2.4 months for children treated without the Kasai procedure vs 2.3 months for those treated with the procedure. The percentages of patients in the group treated without the Kasai procedure presenting at <2 months, 2 to <3 months, 3 to <4 months, 4-6 months, and >6 months of age were 31%, 35%, 15%, 10%, and 9%, respectively, compared to those treated with the Kasai procedure at 36% (P = .38), 44% (P = .12), 16% (P = 1.0), 4% (P = .037), and 0% (P < .001), respectively. The group treated without the Kasai procedure had 1- and 2-year survivals of 52% and 28%, respectively (median survival 6.6 months); in contrast, the group treated with the Kasai procedure had 1- and 2-year transplant-free survivals of 84% and 71%. No patients were treated by liver transplantation because of lack of a liver transplantation program in Vietnam.
  
  
  
  The majority of biliary atresia in Vietnam remains untreated despite early presentation and reasonable outcomes after a Kasai procedure relative to Western countries. These data illustrate the high health care burden for biliary atresia in Vietnam and the need to improve education about biliary atresia and its treatment.
authors.affiliation: Stanford University School of Medicine, Stanford, CA; University of Illinois College of Medicine at Peoria, Peoria, IL.
authors.forename: Max Bolun
authors.initials: MB
authors.lastname: Liu
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Thuy Bui
authors.initials: TB
authors.lastname: Huong
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Xuyen
authors.initials: X
authors.lastname: Hoang
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Lan
authors.initials: L
authors.lastname: Doan
authors.affiliation: New York Medical College, Valhalla, NY.
authors.forename: Shauna
authors.initials: S
authors.lastname: Trinh
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Hoa Pham
authors.initials: HP
authors.lastname: Anh Nguyen
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Hai
authors.initials: H
authors.lastname: Thanh Le
authors.affiliation: University of Illinois College of Medicine at Peoria, Peoria, IL. Electronic address: AiXuan.L.Holterman@osfhealthcare.org.
authors.forename: Ai-Xuan
authors.initials: AX
authors.lastname: Holterman
mesh_terms: D001656:Biliary Atresia / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020380:Needs Assessment; D011171:Portoenterostomy, Hepatic / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014744:Vietnam