Does Kasai operation prior to liver transplantation affect peri-operative outcomes in children with biliary atresia?

Authors

  • Chatdow Choungboonsri Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Pattamon Sutthatarn Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Bunthoon Nonthasoot Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Booncho Sirichindakul Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Wipusit Taesombat Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Maythee Sutherasan Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Supanit Nivatvongs Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Paisarn Vejchapipat Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Keywords:

Biliary atresia, Kasai operation, portoenterostomy, liver transplantation, outcome

Abstract

Background: Biliary atresia is the most leading cause of death from liver disease in children and the most common indication for pediatric liver transplantation. Although portoenterostomy is the mainstay treatment of biliary atresia, there were some studies found that prior portoenterostomy would adversely affect the liver transplant.

Objectives: To compare the peri-operative outcomes between biliary atresia (BA) children having Kasai operation and those with primary liver transplantation (LT).

Methods: Children with BA (0 - 15 years) who underwent LT between 2003 and 2017 were reviewed. Patients were categorized into 2 groups (Group A: BA children undergoing Kasai operation prior to liver transplantation; and, Group B: BA children receiving primary LT, without Kasai operation). Variables that might affect the outcomes were compared. Unpaired t - tests, non-parametric tests, or Fisher’s exact tests were used. Data are expressed as mean and standard deviation.

Results: Fifty-two patients were recruited: Group A (36 patients) and Group B (16 patients). Subjects in Group A had older age when having LT (68.5gif.latex?\pm 77.5 vs. 12.2 gif.latex?\pm 3.3 months, P = 0.006) and lower pediatric end-stage liver disease (PELD) score (age <12 years, 13.1 gif.latex?\pm 8.8 vs. 20.5 gif.latex?\pm 6.7, P = 0.007). However, there was no statistically significant difference in operative time (605.5 gif.latex?\pm 129.6 vs. 563.4 gif.latex?\pm 74.9 min, P = 0.235), warm ischemic time (49.3 gif.latex?\pm 14.1 vs. 45.8 gif.latex?\pm 7.3 min, P = 0.369), intraoperative blood loss (149.5 gif.latex?\pm 248.8 vs. 117.56 gif.latex?\pm 126.93 mL/kg, P = 0.635), total ICU stays (9.9 gif.latex?\pm 9.0 vs. 6.9 gif.latex?\pm 5.9, P = 0.232) and hospital stays (45.3 gif.latex?\pm 31.4 vs. 48.2 gif.latex?\pm 38.3, P = 0.772). Postoperatively, there was no significant difference regarding vascular (3/36 vs. 2/16, P = 0.637) and biliary (5/36 vs. 2/16, P = 1.0) complications between both groups. Additionally, 3-year survival rates following LT between 2 groups were similar (87.8% vs. 93.7%, P = 0.583).

Conclusions: Kasai operation probably delayed the need for LT. The severity (PELD score) was less at the time of LT in children with Kasai operation. It did not adversely affect the peri-operative outcomes of BA patients having liver transplantation. Peri-operative complications, early outcomes and survival rates were comparable.

Downloads

Download data is not yet available.

References

Sundaram SS, Mack CL, Feldman AG, Sokol RJ. Biliary atresia: Indications and timing of liver transplantation and optimization of pretransplant care. Liver Transpl 2017;23:96-109.

https://doi.org/10.1002/lt.24640

Ohi R. Surgical treatment of biliary atresia in the liver transplantation era. Surg Today 1998;28:1229-32.

https://doi.org/10.1007/BF02482804

Hartley JL, Davenport M, Kelly DA. Biliary atresia. Lancet 2009;374:1704-13.

https://doi.org/10.1016/S0140-6736(09)60946-6

Utterson EC, Shepherd RW, Sokol RJ, Bucuvalas J, Magee JC, McDiarmid SV, et al. Biliary atresia: clinical profiles, risk factors, and outcomes of 755 patients listed for liver transplantation. J Pediatr 2005;147:180-5. https://doi.org/10.1016/j.jpeds.2005.04.073

Chandrakamol B, Vejchapipat P, Chittmittrapap S, Poovorawan Y. Biliary atresia: 10-year experience at Chulalongkorn University Hospital. Chula Med J 1996;40:193-202.

Sasaki H, Tanaka H, Wada M, Kazama T, Nishi K, Nakamura M, et al. Liver transplantation following the Kasai procedure in treatment of biliary atresia: a single institution analysis. Pediatr Surg Int 2014;30:871-5. https://doi.org/10.1007/s00383-014-3552-4

Wang P, Xun P, He K, Cai W. Comparison of liver transplantation outcomes in biliary atresia patients with and without prior portoenterostomy: A metaanalysis. Dig Liver Dis 2016;48:347-52.

https://doi.org/10.1016/j.dld.2015.11.021

Wang Q, Yan LN, Zhang MM, Wang WT, Zhao JC, Pu CL, et al. The pre-Kasai procedure in living donor liver transplantation for children with biliary atresia. Hepatobiliary Pancreat Dis Int 2013;12:47-53.

https://doi.org/10.1016/S1499-3872(13)60005-3

Neto JS, Feier FH, Bierrenbach AL, Toscano CM, Fonseca EA, Pugliese R, et al. Impact of Kasai portoenterostomy on liver transplantation outcomes: A retrospective cohort study of 347 children with biliary atresia. Liver Transpl 2015;21:922-7. https://doi.org/10.1002/lt.24132

Sandler AD, Azarow KS, Superina RA. The impact of a previous Kasai procedure on liver transplantation for biliary atresia. J Pediatr Surg 1997;32:416-9. https://doi.org/10.1016/S0022-3468(97)90594-7

Visser BC, Suh I, Hirose S, Rosenthal P, Lee H, Roberts JP, et al. The influence of portoenterostomy on transplantation for biliary atresia. Liver Transpl 2004;10:1279-86. https://doi.org/10.1002/lt.20234

Sanchez-Valle A, Kassira N, Varela VC, Radu SC, Paidas C, Kirby RS. Biliary atresia: Epidemiology, genetics, clinical update, and public health perspective. Adv Pediatr 2017;64:285-305.

https://doi.org/10.1016/j.yapd.2017.03.012

Fanna M, Baptiste A, Capito C, Ortego R, Pacifico R, Lesage F, et al. Preoperative risk factors for intraoperative bleeding in pediatric liver transplantation. Pediatr Transplant 2016;20:1065-71.

https://doi.org/10.1111/petr.12794

Li S, Ma N, Meng X, Zhang W, Sun C, Dong C, et al. The effects of Kasai procedure on living donor liver transplantation for children with biliary atresia. J Pediatr Surg 2019;54:1436-9.

https://doi.org/10.1016/j.jpedsurg.2018.07.022

Downloads

Published

2023-10-17

How to Cite

1.
Choungboonsri C, Sutthatarn P, Nonthasoot B, Sirichindakul B, Taesombat W, Sutherasan M, Nivatvongs S, Vejchapipat P. Does Kasai operation prior to liver transplantation affect peri-operative outcomes in children with biliary atresia?. Chula Med J [Internet]. 2023 Oct. 17 [cited 2024 Oct. 12];65(1). Available from: https://he05.tci-thaijo.org/index.php/CMJ/article/view/1074