Relevant factors for early liver transplantation after Kasai portoenterostomy
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RESEARCH ARTICLE
Open Access
Relevant factors for early liver transplantation after Kasai portoenterostomy Liang Ge1, Jianghua Zhan2* , Wei Gao3, Shengqiao Zhao1, Xiaodan Xu1 and Ran Dou1
Abstract Background: To explore the relevant factors for early liver transplantation (LT) after Kasai portoenterostomy (KP). Methods: Retrospective analysis was performed for 200 children with biliary atresia, who underwent LT with hepatic failure after KP. According to the interval between KP and LT, they were divided into three groups: G1 (≤6month), G2 (6-month~ 2-year) and G3 (> 2-year). Gender, age of Kasai portoenterostomy, jaundice-clearance, cholangitis after KP and liver function indexes before LT were compared among the three groups. Results: The proportion of patients with age of KP (≤90-day) in G1 was lower than that in G3 (P = 0.003). Jaundiceclearance occurred in 6 (7.6%), 26(28.6%) and 26 (86.7%) patients after KP in G1, G2 and G3 respectively (P < 0.001). There were statistical differences in the incidence of early cholangitis, late cholangitis and repeated cholangitis among the three groups (P = 0.035, < 0.001 and 0.022). The native liver survival (NLS) rate of children at operation age > 90-day was lower than that of children at operation age ≤ 90-day (P = 0.002). The NLS rate of the children with jaundice-clearance after KP was significantly better than that of the children without jaundice-clearance (P < 0.001). The NLS rate of the children with early cholangitis after operation was lower than that in children without early cholangitis (P = 0.026). The NLS rate of patients of G2 and G3 with cholangitis after KP was lower than that in children without cholangitis (P = 0.017). Multiple logistic regression analysis showed uncleared jaundice after KP was a risk factor for the NLS time in patients. Conclusion: The age of KP (> 90-day), jaundice-unclear and early cholangitis could reduce the NLS time after KP, which were related to early liver transplantation. Jaundice-unclear was a risk factor for early liver transplantation. Keywords: Biliary atresia, Liver transplantation, Relevant factors, Kasai portoenterostomy
Background Biliary atresia (BA), characterized by progressive inflammation and fibrous obstruction of hepatic bile ducts, is a serious hepatobiliary disease in infancy. It can lead to cholestasis, hepatic fibrosis and cirrhosis. Kasai portoenterostomy has been a primary operation for biliary atresia since professor Morio Kasai first performed in 1959. * Correspondence: [email protected] 2 Department of Pediatric Surgery, Tianjin Children’s Hospital, LongYan Road 238, Beichen District, Tianjin 300134, PR China Full list of author information is available at the end of the article
Shinkai et al. [1] reported that the 5-, 10-, and 20-year survival rates of patients with their native livers were 63, 54, and 44%, respectively. Nio [2] reported that 20-year native-liver survival rate was 49%. However, the native liver survival after KP in mainland China is not optimistic. Only less than 30% of the pati
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