Long-term native liver survival in infants with biliary atresia and use of a stool color card: Case-control study.

BACKGROUND: So far, there has been no epidemiological study on whether long-term native liver survival (NLS) in infants with biliary atresia (BA) is associated with use of a stool color card (SCC). METHODS: A case-control study was performed, involving two associations for patients with BA in Japan. Participants were patients with BA who were born and underwent their first open Kasai procedures (KP) between August 1994 and March 2011, and who were also members of either of two associations for patients with BA in Japan. SCC users were classified as cases and SCC non-users as controls. RESULTS: Mean age at the time of the first open KP was 59.7 and 68.2 days in SCC users and non-users, respectively (P < 0.05). According to Kaplan-Meier analysis, the probability of NLS at 12.5 years was 48.5% and 36.6% in SCC users and non-users (P < 0.05), respectively. On Cox proportional hazard modeling, not using an SCC was harmful to long-term NLS (hazard ratio, 2.61; 95% CI: 1.20-5.70; P = 0.016), adjusted for sex, age of timing of KP and type of BA. CONCLUSIONS: Long-term NLS is associated with SCC for early detection, but not associated with age or a threshold of age at KP (<90 days) in patients with BA.