Lorraine I Kelley-Quon1,2, Eveline Shue3, Rita V Burke4, Caitlin Smith5, Karen Kling6, Elaa Mahdi3, Shadassa Ourshalimian3, Michael Fenlon3, Matthew Dellinger5, Stephen B Shew7, Justin Lee8, Benjamin Padilla8, Thomas Inge9, Jonathan Roach9, Ahmed I Marwan9, Katie W Russell10, Romeo Ignacio6, Elizabeth Fialkowski11, Amar Nijagal12, Cecilia Im12, Kenneth S Azarow11, Daniel J Ostlie8, Kasper Wang3. 1. Division of Pediatric Surgery, Children's Hospital Los Angeles and the Keck School of Medicine, University of Southern California, 4650 Sunset Blvd. MS #100, Los Angeles, CA, 90027, USA. lkquon@chla.usc.edu. 2. Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. lkquon@chla.usc.edu. 3. Division of Pediatric Surgery, Children's Hospital Los Angeles and the Keck School of Medicine, University of Southern California, 4650 Sunset Blvd. MS #100, Los Angeles, CA, 90027, USA. 4. Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 5. Division of Pediatric General and Thoracic Surgery, Department of Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA. 6. Department of Pediatric Surgery, Rady Children's Hospital San Diego, University of California School of Medicine, San Diego, CA, USA. 7. Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA. 8. Division of Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA. 9. Department of Surgery, University of Colorado Denver School of Medicine and Children's Hospital of Colorado, Aurora, CO, USA. 10. Division of Pediatric Surgery, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA. 11. Division of Pediatric Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA. 12. Division of Pediatric Surgery, University of California, San Francisco, CA, USA.
Abstract
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.
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.
Authors: Paul G Toomey; Anthony F Teta; Krishen D Patel; Sharona B Ross; Alexander S Rosemurgy Journal: Am J Surg Date: 2015-11-02 Impact factor: 2.565