The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study

Autor: Kenneth S. Azarow, Michael Fenlon, Caitlin A. Smith, Justin Lee, Eveline Shue, Elizabeth A. Fialkowski, Shadassa Ourshalimian, Benjamin E. Padilla, Karen Kling, Ahmed I. Marwan, Elaa Mahdi, Matthew B. Dellinger, Daniel J. Ostlie, Stephen B. Shew, Kasper S. Wang, Katie W. Russell, Rita V. Burke, Cecilia Im, Lorraine I. Kelley-Quon, Thomas H. Inge, Amar Nijagal, Jonathan P. Roach, Romeo Ignacio
Rok vydání: 2022
Předmět:
Pediatrics
medicine.medical_specialty
Referral
Psychological intervention
Portoenterostomy
Hepatic
Logistic regression
Article
Oral and gastrointestinal
Paediatrics and Reproductive Medicine
Rare Diseases
Hepatic
Biliary atresia
Biliary Atresia
Clinical Research
Pediatric surgery
Medicine
Humans
Liver transplant
Retrospective Studies
Pediatric
Surgical approach
business.industry
Liver Disease
Prevention
Infant
Evaluation of treatments and therapeutic interventions
Retrospective cohort study
General Medicine
Portoenterostomy
Perinatal Period - Conditions Originating in Perinatal Period
medicine.disease
Liver Transplantation
Treatment Outcome
Good Health and Well Being
Pediatrics
Perinatology and Child Health
Surgery
Transplant-free survival
business
Digestive Diseases
Liver pathology
6.4 Surgery
Kasai portoenterostomy
Zdroj: Pediatric surgery international, vol 38, iss 2
Pediatr Surg Int
Popis: PURPOSE The purpose of this study was to investigate factors impacting transplant-free survival among infants with biliary atresia. METHODS A multi-institutional, retrospective cohort study was performed at nine tertiary-level children's hospitals in the United States. Infants who underwent Kasai portoenterostomy (KP) from January 2009 to May 2017 were identified. Clinical characteristics included age at time of KP, steroid use, surgical approach, liver pathology, and surgeon experience. Likelihood of transplant-free survival (TFS) was evaluated using logistic regression, adjusting for patient and surgeon-level factors. Secondary outcomes at 1 year included readmission, cholangitis, reoperation, mortality, and biliary clearance. RESULTS Overall, 223 infants underwent KP, and 91 (40.8%) survived with their native liver. Mean age at surgery was 63.9 days (± 24.7 days). At 1 year, 78.5% experienced readmission, 56.9% developed cholangitis, 3.8% had a surgical revision, and 5 died. Biliary clearance at 3 months was achieved in 76.6%. Controlling for patient and surgeon-level factors, each additional day of age toward operation was associated with a 2% decrease in likelihood of TFS (OR 0.98, 95% CI 0.97-0.99). CONCLUSION Earlier surgical intervention by Kasai portoenterostomy at tertiary-level centers significantly increases likelihood for TFS. Policy-level interventions to facilitate early screening and surgical referral for infants with biliary atresia are warranted to improve outcomes.
Databáze: OpenAIRE
Externí odkaz: