Cholestasis after Kasai operation predicts portal hypertension in native liver survivors of biliary atresia: a multicenter study.
Pediatr Surg Int
; 40(1): 196, 2024 Jul 17.
Article
em En
| MEDLINE
| ID: mdl-39017953
ABSTRACT
PURPOSE:
This study evaluated portal hypertension (PHT) and its predictors among native liver survivors (NLS) of biliary atresia (BA) after Kasai portoenterostomy (KPE).METHODS:
This was a multicenter study using prospectively collected data. The subjects were patients who remained transplant-free for 5 years after KPE. Their status of PHT was evaluated and variables that predicted PHT were determined by regression analysis and receiver operating characteristic (ROC) curve.RESULTS:
Six centers from East Asia participated in this study and 320 subjects with KPE between 1980 to 2018 were analyzed. The mean follow-up period was 10.6 ± 6.2 years. At the 5th year after KPE, PHT was found in 37.8% of the subjects (n = 121). Patients with KPE done before day 41 of life had the lowest percentage of PHT compared to operation at older age. At 12 months after KPE, PHT + ve subjects had a higher bilirubin level (27.1 ± 11.7 vs 12.3 ± 7.9 µmol/L, p = 0.000) and persistent jaundice conferred a higher risk for PHT (OR = 12.9 [9.2-15.4], p = 0.000). ROC analysis demonstrated that a bilirubin level above 38 µmol/L at 12 months after KPE predicted PHT development (sensitivity 78%, specificity 60%, AUROC 0.75).CONCLUSIONS:
In BA, early KPE protects against the development of PHT among NLSs. Patients with persistent cholestasis at one year after KPE are at a higher risk of this complication. They should receive a more vigilant follow-up. LEVEL OF EVIDENCE Level III.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Atresia Biliar
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Portoenterostomia Hepática
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Colestase
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Hipertensão Portal
Limite:
Child, preschool
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Female
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Humans
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Infant
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Male
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Newborn
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article