Prognostic factors determining the surgical interference of biliary atresia in Egyptian infants: single-center experience

Abstract

Abstract Background Biliary atresia is associated with considerable morbidity, and it is the most frequent indication for pediatric liver transplantation. Hepatic portoentostomy (HPE), Kasai procedure, is used commonly as the first line of treatment but its long-term efficacy still remains controversial. In this study we decided to illustrate most of the perioperative clinical, biomarkers, histopathological, and surgical parameters that may determine the outcome in operated infants with biliary atresia within 5 years at our center at national liver institute (NLI). We analyzed the perioperative risks for surgical failure in 100 infants with BA, diagnosed and treated from June 2012 to June 2017. Infant included in the study categorized into two groups according to the surgical outcome, failed and successful group. The successful surgical outcome of biliary atresia was determined by the clearance of jaundice within 6 months where total serum bilirubin ≤ 2 mg/dL. Both groups were compared according to perioperative clinical, laboratory, ultrasonographic, endoscopic detection of bile, histopathological characteristics, excised biliary remnant duct size, and type of surgical interference. Results After surgical interference, infants with successful outcome were 33% and those with failed outcome were 67%. Younger age, lower preoperative serum GGT, delayed onset of jaundice after the first 2 weeks of life, and lower levels of post-operative 1-month serum total and direct bilirubin, were significantly associated with successful outcome (P = 0.001, 0.041, 0.025, and 0.001 respectively). Also gall bladder contractility, endoscopic duodenal bile test, degree of hepatic fibrosis, bile duct size, surgical type of BA, and type of surgical interference were significant risk factors affecting the surgical outcome of BA (P = 0.003, 0.037, 0.005, 0.024, 0.001, and 0.002 respectively). Conclusions Younger age and lower preoperative GGT and post-operative 1-month serum total and direct bilirubin level are good predictors for the surgical outcome of BA infants with better performance of age and post-operative 1-month serum total and direct bilirubin level. This may determine infants with the high-priority for transplant referral postoperatively.