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23.03.2022 | Original Article

Portal plate bile duct diameter in biliary atresia is associated with long-term outcome

verfasst von: Michael Shpoliansky, Ana Tobar, Yael Mozer-Glassberg, Michal Rosenfeld Bar-Lev, Raanan Shamir, Michal Shafir, Michael Gurevich, Orith Waisbourd-Zinman

Erschienen in: Pediatric Surgery International | Ausgabe 6/2022

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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.

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Titel: Portal plate bile duct diameter in biliary atresia is associated with long-term outcome
verfasst von: Michael Shpoliansky
Ana Tobar
Yael Mozer-Glassberg
Michal Rosenfeld Bar-Lev
Raanan Shamir
Michal Shafir
Michael Gurevich
Orith Waisbourd-Zinman
Publikationsdatum: 23.03.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 6/2022
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-022-05113-2

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Portal plate bile duct diameter in biliary atresia is associated with long-term outcome