Publication: Factors related to the clinical outcomes of the kasai procedure in infants with biliary atresia
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Issued Date
2020-05-01
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22288082
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2-s2.0-85087091078
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Mahidol University
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SCOPUS
Bibliographic Citation
Siriraj Medical Journal. Vol.72, No.3 (2020), 226-237
Suggested Citation
Mongkol Laohapensang, Patcharaphan Srikuancharoen, Niramol Tantemsapya Factors related to the clinical outcomes of the kasai procedure in infants with biliary atresia. Siriraj Medical Journal. Vol.72, No.3 (2020), 226-237. doi:10.33192/SMJ.2020.31 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/58189
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Title
Factors related to the clinical outcomes of the kasai procedure in infants with biliary atresia
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Abstract
© 2020, Faculty of Medicine Siriraj Hospital, Mahidol University. Objective: The Kasai portoenterostomy has been accepted as the primary therapeutic treatment for biliary atresia. However, successful bile drainage does not always promise a long-term native liver survival. Several clinical factors were evaluated to discover associations with the outcomes. Methods: A retrospective chart review was conducted of infants with biliary atresia who underwent the conventional Kasai portoenterostomy at Siriraj Hospital, January 2006-August 2018. The patient demographics, perioperative clinical and laboratory data, adjuvant therapies, complications, and interventions were analyzed in correlation to the short-and long-term outcomes. The short-term outcome evaluated was the resolution of jaundice, while the long-term outcome was remaining jaundice-free with the native liver. Results: The complete medical records of 80 patients were retrospectively reviewed. Their mean age at the time of the Kasai portoenterostomies was 97 days. Overall, 66.3% achieved jaundice clearance. The mean follow-up duration was 50.5 months, with 51.3% of the patients remaining jaundice-free with their native liver. A prolonged duration of a prophylactic antibiotic was significantly related to the jaundice clearance, with a p-value of 0.002. Moreover, a lower number of episodes of cholangitis was significantly related to a good long-term outcome (p-value, 0.024). Conclusion: The prolonged provision of a prophylactic antibiotic as adjuvant therapy after the Kasai portoenterostomy was associated with jaundice clearance. An increased incidence of cholangitis episodes was associated with poor long-term outcomes. Postoperative adjuvant therapy should be standardized and maintained for the care of biliary atresia patients to improve their outcomes.