Prognostic factors and outcomes of Kasai portoenterostomy (KPE): nine-year experience from a lower-middle income country

Abstract

Outcome data after Kasai Portoenterostomy (KPE) reported worldwide shows considerable regional and institutional variation. It is not known whether the same standards of outcomes reported in western world can be replicated in resource-poor countries. MethodsWe reviewed 79 patients of which 43 had completed a 2-year minimum follow-up. Two cohorts were based on age at KPE. Median age at surgery was 60 days. ResultsClearance of jaundice (COJ) at 3 months was 20.93% and was not affected by age at surgery (p = 0.295).Four patients (9.3%) received liver transplant and 16 patients (37.21%) were recorded dead at a median age of 7 months. Native liver survival (NLS) was 53.49% and Overall survival (OS) was 62.79%. Kaplan-Meier estimated 4-and 6-year NLS were 55.8% and 49.6% respectively. There was a signi cant difference in the NLS between early and late surgery groups. ConclusionWhilst causes for low COJ need to be explored, this data rea rm that early surgery has a signi cant favorable effect on survival. NLS was comparable with data from the developed world whereas low OS is explained by limited access to transplant. Thus, where the survival depends on native liver longevity, emphasis should be on as early KPE as possible.

Delphi Method Analysis and Consensus of Prevalent Distinctive Practices for Biliary Atresia Management after Kasai Portoenterostomy

“…The outcome of KPE can be assessed clinically with a change in stool color, a decrease in icterus, a fall in bilirubin levels, and enzymes in LFT. [ 34 ] Early age at KPE and prevention of cholangitis result in successful KPE. [ 35 ] Most experts in our study also depend on clinical assessment and LFT to assess the outcome of KPE rather than HIDA scan.…”