Evaluation of the Factors Contributing to the Failure of the Kasai Portoenterostomy

Feb 08, 2023

The following is a summary of “What Makes A “Successful” Kasai Portoenterostomy “Unsuccessful”?,” published in the January 2023 issue of Gastroenterology and Nutrition by Matcovici, et al.

The first major goal of a Kasai portoenterostomy (KPE) for biliary atresia (BA) is the clearing of jaundice (CoJ), and its accomplishment was by far the strongest indicator of long-term prognosis. For a study, researchers aimed to pinpoint the causes of failure [after liver transplantation (LT)].

It was a single-center prospective BA database review. A postoperative bilirubin of ≤20 µmol/L was the threshold for successful KPE. A multivariate logistic regression model was used to determine the factors pre- and post-KPE that may be seen three months after KPE. Data is presented as a median (range) P ≤0.05 was considered significant.

About 90 (67%) of the 135 infants who received KPE between January 2012 and December 2018 were successful in achieving CoJ. Of them, 20 (22%; cohort A) underwent LT, with the remaining patients (cohort B) continuing to receive native liver (median follow-up of 4.15 years). Age at KPE (P = 0.41), APRi (aspartate aminotransferase-to-platelet ratio) (P = 0.07), related abnormalities (P = 0.7), and CMV status did not change between the two groups (P = 0.7). Postoperatively, cohort A had substantially higher rates of cholangitis (any episode, 18/20 (90%) vs. 15/70 (21%); P< 0.0001) and portal hypertension (PHT) (gastrointestinal (GI) bleed, 10/20 (50%) vs. 2/70 (2.8%); P< 0.0001). High APRi, bilirubin, international normalized ratio, and ultrasound (US)-detected ascites were the variables with the most significant predictive values at 3 months for LT by 2 years, according to univariate analysis, and multivariate logistic modeling confirmed the variables with predictive values of r² = 0.79 and AUROC = 0.98.