Effects of the infant stool color card screening program on 5-year outcome of biliary atresia in taiwan

Abstract

In Taiwan, a screening system using an infant stool color card to promote the early diagnosis of biliary atresia (BA) was established in 2002. This study aimed to investigate the 5-year outcome of BA before and after using the screening program. BA patients were divided into three cohorts according to their birth dates. The patients in cohort A (n 5 89) were born before the stool card screening program (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000); those in cohort B (n 5 28) were screened by the stool card regional screening program (2002)(2003); and those in cohort C (n 5 74) were screened by the stool card universal screening program (2004)(2005). The relative odds ratios were computed using logistic regression to compare the different factors affecting survival time. The rate of age at Kasai operation <60 days was 49.4% and 65.7% in cohorts A and B1C, respectively (P 5 0.02). The jaundice-free (total serum bilirubin <2.0 mg/dL) rate 3 months after surgery was 34.8% and 60.8% in cohorts A and B1C, respectively (P < 0.001). The 3-year jaundice-free survival rate with native liver was 31.5% in cohort A and 56.9% in cohort B1C (P < 0.001), whereas the 3-year overall survival rates were 64.0% and 89.2%, respectively (P < 0.001). The 5-year jaundice-free survival rate with native liver was 27.3% in cohort A and 64.3% in cohort B (P < 0.001), and the 5-year overall survival rates were 55.7% and 89.3%, respectively (P < 0.001). Conclusion: The stool color card screening program for BA allows for earlier Kasai operation, which increases the jaundice-free rate at 3 months postsurgery. With higher surgical success rates, the 3-and 5-year outcome of BA patients in Taiwan improves remarkably. (HEPATOLOGY 2011;53:202-208)

Stool Color Card Screening for Early Detection of Biliary Atresia and Long-Term Native Liver Survival: A 19-Year Cohort Study in Japan

“…11 Although the stool color card has been adopted and used in Taiwan, 14 Argentina, 25 and Switzerland, 26 the outcome was only reported in Taiwan, where the 5-year native liver survival rate (without jaundice) was 64.3% (18/28). 27 According to JBAR data, the mean and median age at Kasai procedure was not significantly different between the periods of 1994-2002 and 2003-2011 ( Table I), suggesting that the management of patients with biliary atresia did not change drastically over the years. Hence, the improvement of the probability of native liver survival revealed in this study is likely to be attributable to the younger age at Kasai procedure as a result of stool color card usage.…”

National centralization of biliary atresia care to an assigned multidisciplinary team provides high-quality outcomes

“…The first-line treatment of BA is the Kasai portoenterostomy (PE) where the fibrotic remnant of until adulthood giving the patients a better chance of survival [9][10][11][12]. Increased age at PE progressively worsens outcomes in terms of clearance of jaundice and native liver survival [13,14]. Other factors possibly affecting the outcome include the extent of liver fibrosis at PE and center experience [7].…”

Patients With Biliary Atresia Have Elevated Direct/Conjugated Bilirubin Levels Shortly After Birth

“…12,13 DB/CB screening bypasses limitations of other proposed BA screening tests, such as measuring conjugated bile acids on newborn spot cards (overlap between BA and control values), or detecting acholic stools by using an "infant stool color card" (which requires parents to make subjective decisions on the basis of what they perceive as stool color). [14][15][16][17][18] Most important is that universal DB/CB level screening is an extremely sensitive early test for BA. In this study, all 84 DB or CB levels measured between 0 and 96 HoL were elevated in subjects who were eventually diagnosed with BA.…”