Sequential Operation of Kasai Portoenterostomy and Liver Transplantation is Recommended in Biliary Atresia Children for Better Outcomes: A Propensity Score Matching Analysis

Abstract

Abstract Background Kasai portoenterostomy (KPE) is widely accepted for biliary atresia (BA) when diagnosed timely. However, the outcomes for many patients were not satisfactory and required liver transplantation (LT) subsequently. The aim of our study was to determine whether KPE could improve the post-transplant outcomes of BA children. Methods In this retrospective cohort study from 2006 to 2019, 1647 BA children were included and divided into two cohorts: those who underwent primary liver transplantation (pLT) (n = 599) and those who received KPE followed by LT (n = 1048). Propensity score matching (PSM) was conducted in a 1:1 ratio to balance basic characteristics and minimize the selection bias. Results Of 954 recipients after PSM, pLT group (n = 477) showed poor survival rate than KPE + LT group (n = 477) (p < 0.001), with 1-year survival rate of 87.2% and 94.7%, 5-year survival rate of 82.4% and 91.9% respectively. 59.2% of deaths happened within post-operative day 90, especially the first month (41.7%) after LT. pLT group had a significant higher mortality rate than KPE + LT group (15.5% vs 6.1%, p < 0.001). Pulmonary infection and post-LT liver failure were leading causes of death in pLT group compared with KPE + LT group. Conclusions KPE could improve the post-transplant survival for BA children. If diagnosed within 3 months, it is advisable to try KPE before considering LT for BA children.