Abstract
Purpose: Kasai's operation is still the initial step in the management of biliary atresia (BA). This study aims to identify the early factors predicting the event-free survival after Kasai portoenterostomy (KPE).Materials and Methods: In this retrospective study, records of 35 cases that underwent KPE between 2000 and 2012 were reviewed. Cases who died or needed liver transplantation were defined as the poor prognosis group (PPG) (n=21) and cases with event-free survival were defined as the good prognosis group (GPG)(n=14). Demographic data, preoperative and postoperative liver function test results, and pathology reports were analyzed. Non-parametric and receiver operating characteristic (ROC) tests for cut-off values were used.Results: Serum levels of total bilirubin (TB) and direct bilirubin (DB) after KPE were 10.9 mg/dL (6.6-22.3 mg/dL) and 8.6 mg/dL (5.1-16.1 mg/dL) for PPG, and 8.3 mg/dL (4.0-14.2 mg/dL) and 5.7 mg/dL (2.9-10.2 mg/dL) in GPG; both showed significant difference (p=0.004, p=0.003). The ROC analyses determined the optimal cut-off values were 8.84 mg/dL for TB with 75% sensitivity and 62% specificity; and 7.21 mg/dL for DB with 79% sensitivity and 65% specificity. Ductal plate malformation (DPM) was reported in 4 cases (29%) in GPG and in none of the cases of PPG (p = 0.047).Conclusion: Serum DB and TB levels early after KPE may be reliable early predictors of event-free survival. DPM may be a good prognostic factor, but larger case groups should be studied.