Factors Affecting the Success Rate of Kasai Portoenterostomy

Sastiono, Sastiono; Maheranny, Marethania; Oswari, Hanifah

doi:10.7454/nrjs.v1i1.8

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…12 Operative therapy with KPE is still chosen with a success rate that depends on the degree of fibrosis process of the liver which is an advanced process of biliary atresia. 13 A study in Indonesia showed the success of KPE was 51.7%. 14 Meanwhile, another study examined the outcome of patients who underwent KPE and found that the mortality rate was 58.5% with the main causes being sepsis and liver failure.…”

Section: Discussionmentioning

confidence: 99%

Steroid therapy in extrahepatic cholestasis suggestive of biliary atresia: A case report

Syahbani,

Prihaningtyas,

Setyoboedi

et al. 2024

Bioscmed

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Background: Biliary atresia is a fibroinflammatory disease obstructing the extrahepatic biliary system. Biliary atresia is the leading cause of cholestasis in infants and the cause of end-stage liver disease in the first two years of life. Surgical treatment with Kasai portoenterostomy has been performed but has not eliminated the need for liver transplantation. The consideration of adjuvant steroid therapy for suppressing the fibro-inflammatory process in the bile ducts may improve the outcome of extrahepatic cholestasis. Case Presentation: A case of a 2-month 7-day-old boy with a chief complaint of jaundice with suspicion of biliary atresia. Jaundice started 1 week after birth, followed by acholic stools, yellow-brown urine, distended abdomen, hepatomegaly, and visible abdominal veins. Laboratory examination revealed an elevated level of direct bilirubin (cholestasis) in combination with elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and Gamma-glutamyl transferase (GGT), hypoalbuminemia, and reactive of IgG and IgM CMV. A percutaneous liver biopsy was performed and showed extrahepatic cholestasis with mild fibrosis consistent with biliary atresia. The patient was treated with oral methylprednisolone and ursodeoxycholic acid (UDCA). After 12 weeks of therapy, the patient was free of jaundice and darkening of stool color, followed by a normal bilirubin level. Conclusion: In young infants with extrahepatic cholestasis suggestive of biliary atresia, steroid administration resulted in clinical and laboratory improvement. The involvement of the immune response in the pathogenesis of biliary atresia may suggest new therapeutic targets for biliary atresia, such as steroids for improving the outcome of biliary atresia in young infants.

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Section: Discussionmentioning

confidence: 99%

Steroid therapy in extrahepatic cholestasis suggestive of biliary atresia: A case report

Syahbani,

Prihaningtyas,

Setyoboedi

et al. 2024

Bioscmed

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“…The discrepancies in findings may result from differences between antibiotics regimens and duration. Additionally, several factors have been mentioned to affect the success rate of Kasai HPE: early age (before 7th week of life), ductal plate malformation, postoperative steroid, prevention of cholangitis, and the degree of fibrosis (29)(30)(31)(32). The latter has been associated with serum IL-8 and IL-6 indicating inflammation and predicting fibrosis (33), while a shorter Roux-loop length in Kasai HPE had a similar efficacy as the conventional length (34).…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Antibiotics to Prevent Cholangitis in Children with Biliary Atresia After Kasai Portoenterostomy: A Meta-Analysis

Alatas,

Lazarus,

Junaidi

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: A connection between the bowel and bile ducts after the Kasai hepatoportoenterostomy (HPE) procedure poses a risk of ascending cholangitis. There were only a few evidence-based consensuses on the benefits of prophylactic antibiotics. This study aims to assess the value of prophylactic antibiotics in reducing the risk of cholangitis following the Kasai HPE procedure. Methods: Meta-analysis is performed using random-effects model from the search result of five online databases (PubMed, Google Scholar, EBSCO MEDLINE, ClinicalTrials.gov, and EuropePMC) from inception to October 27 th, 2021. The keywords used were “antibiotic”, “antimicrobial”, “Kasai”, “portoenterostomy”, “biliary atresia”, and “bile duct atresia”. Cochrane Risk of Bias tool and Newcastle Ottawa Scale is used to assess the risk of bias. The outcomes are incidence of cholangitis and native liver survival. Results: Six studies consisting of four cohorts and two cross-sectional studies were extracted. A total of 714 patients reported different cholangitis incidence after prophylactic antibiotics administration post-Kasai HPE. The incidence of cholangitis following Kasai HPE was not statistically significant among participants. There is conflicting evidence on the efficacy of antibiotics in prolonging native liver survival. Conclusions: The existing evidence does not support the administration of prophylactic antibiotics in preventing cholangitis after Kasai HPE among biliary atresia patients. Additionally, their roles in native liver survival are still inconclusive. The fact that there were heterogeneous method and antibiotic usage between existing studies must also be highlighted for better design in future studies.

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“…It was reported by Sastiono et al . [16] that the success rate was 33.3% in those operated on below the age of 90 days. Another study by Schoen et al .…”

Section: Discussionmentioning

confidence: 99%

Preoperative alkaline phosphatase is a potential predictor of short-term outcome of surgery in infants with biliary atresia

Abdel-Aziz

Sira

Gad

et al. 2019

ceh

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Aim of the study Biliary atresia (BA) is a fibro-inflammatory cholangiopathy of intra- and extrahepatic biliary radicles. The standard-of-care treatment is surgical restoration of bile flow by Kasai hepatoportoenterostomy (HPE). We aimed to identify the predictors of short-term outcome of the Kasai operation three months postoperatively. Material and methods This retrospective study included 107 infants diagnosed with BA by intraoperative cholangiography. All underwent a Kasai operation. The surgical outcome was classified after 3 months post-operatively as successful (bilirubin ≤ 2 mg/dl) or failed (bilirubin > 2 mg/dl). The two groups were compared according to basic clinical, ultrasonographic and histopathological characteristics. Results Of the studied patients 29 (27.1%) had a successful outcome while 78 (72.9%) had failed Kasai HPE. Of the preoperative characteristics, lower age and lower serum alkaline phosphatase (ALP) were significantly associated with successful surgical outcome ( p = 0.009 and < 0.0001, respectively). In addition, surgical type of BA affected the short-term outcome ( p = 0.017), while there was no statistically significant difference regarding the other studied parameters between groups. Age of 69.5 days or less was predictive of successful outcome with 74.4% specificity but with low sensitivity (58.6%), and ALP at a cutoff level of 532.5 U/l or less was predictive of successful outcome with 75.9% sensitivity and 74.4% specificity. Conclusions Younger age at the time of surgery and lower ALP are good predictors for the short-term outcome of Kasai HPE with better performance of ALP. This may help to anticipate those who can benefit from surgical correction and those who should be given high priority for transplant referral.

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Factors Affecting the Success Rate of Kasai Portoenterostomy

Cited by 4 publications

References 4 publications

Steroid therapy in extrahepatic cholestasis suggestive of biliary atresia: A case report

Steroid therapy in extrahepatic cholestasis suggestive of biliary atresia: A case report

Prophylactic Antibiotics to Prevent Cholangitis in Children with Biliary Atresia After Kasai Portoenterostomy: A Meta-Analysis

Preoperative alkaline phosphatase is a potential predictor of short-term outcome of surgery in infants with biliary atresia

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