Portal plate bile duct diameter in biliary atresia is associated with long-term outcome
link.springer.com shows its articles on its own site.
Read the article on link.springer.com ↗Article · Mar 2022 · 1 min read
In brief
In brief
Retrospective study of 77 biliary atresia patients finds that portal plate bile duct diameter ≥50 µm at Kasai portoenterostomy correlates with surgical success and improved 10-year transplant-free survival. Direct bilirubin <1 mg/dl at 3 months post-op predicts 2-year transplant-free survival, offering clinicians measurable prognostic markers.
Written by the GCMD Library team from the article.
Abstract
Purpose
Kasai portoenterostomy (KPE) is the only treatment currently available for biliary atresia (BA). Age at KPE and surgical experience are prognostic factors for a successful KPE. Here, we aimed to assess whether the size of bile ductules at the porta hepatis during KPE correlates with KPE success and transplant-free survival (TFS).
Methods
A retrospective analysis of patients diagnosed with BA during 2000–2019. Porta hepatis biopsies were reviewed for diameters of five representative ducts, and a mean ductal diameter (MDD) was calculated. Laboratory values including pre- and postoperative bilirubin levels were analyzed.
Results
The cohort included 77 patients; for 33, ductal plate biopsy was available. KPE was successful in six of eight patients with MDD ≥ 50 µm, and in five of 25 with MDD < 50 µm, p = 0.008, OR = 12.0 (95% CI 1.83–78.3). Ten-year survival with native liver was higher in patients with MDD ≥ 50 µm than in patients with MDD < 50 µm, p < 0.001, HR 0.038 (95% CI 0.007–0.207). Direct bilirubin < 1 mg/dl 3 months post-KPE was associated with improved 2-year post-KPE TFS (27.7% vs. 13.9%, p < 0.0001).
Conclusions
MDD ≥ 50 µm correlates with KPE success and a higher rate of TFS. Direct bilirubin < 1 mg/dl 3 months post-operation may serve as a marker of successful biliary excretion, and a predictor of 2-year TFS.