Bilirubin levels at 1st and 3rd postoperative months are significant in determining the success of the Kasai portoenterostomy

INTRODUCTION: The aim of this retrospective study is to determine the indicators of survival with native liver of patients operated for biliary atresia (BA).
METHODS: Review included 53 BA patients in 13-year period. There were two groups: (1) surviving with native liver (NLS) and (2) necessitating transplantation (LTx). Age at operation, bilirubin levels on 7th day, 1st and 3rd months postoperatively were recorded. Mann Whitney-U and Logistic Regression Analysis were used for statistical analysis for survival with NL and LTx.
RESULTS: Kasai Portoenterostomy (KPE) was performed in 38 patients, and 15 were directed to LTx due to cirrhotic liver at presentation. Twenty-three of 38 patients with KPE survived with native liver, and 15/38 patients required LTx during follow up. Mean age at portoenterostomy for NLS and LTx was 54.43∓24.64 and 68.33∓24.35 days respectively(p>0.05). 1st and 3rd month bilirubin levels were lower in NLS group (p<0.01). 1st month and 3rd month bilirubin levels after KP were significant predictors for survival with NLS. Cut-off value of 5.7mg/dl bilirubin level at 1st month predicted the necessity of transplantation after KPE with a sensitivity of 83.3% and specificity of 78.9%.
DISCUSSION AND CONCLUSION: Bilirubin levels of 1st and 3rd months are reliable predictors for success of portoenterostomy.