Biliary drainage surgery before or after 3 months of life versus primary liver transplantation in children with biliary atresia: comparative cohort study

This cohort study of 424 children with biliary atresia demonstrates that biliary drainage surgery (Kasai procedure) performed after 90 days of age still provides significant transplant-free survival benefit compared to primary liver transplantation, with comparable long-term overall survival. Age alone should not contraindicate Kasai surgery in late-diagnosed patients.