Introduction

Infants with biliary atresia (BA) identified “later” (typically after 90 days of life) present a management challenge, as late Kasai portoenterostomy (KP) has high failure rates and may complicate the operative field for future liver transplant (LT). The objective of this study is to compare the clinical course and complications of failed KPs versus no KPs in the UNOS database.

Methods

Data collected UNOS included subjects listed with BA listed for primary liver transplant between 2002 and 2016. Student t-tests were used to compare pre- and post-operative data between two groups: (i) those with previous abdominal surgery and total bilirubin (TB) > 6 mg/dL (failed KP group), and (ii) those with no previous abdominal surgery and TB > 2 mg/dL (no KP group).

Results

There were 1085 subjects with failed KP and 303 subjects with no KP. At listing, there was a significant difference in ethnicity (40% vs. 52% White and 26% vs. 16% Black in failed KP vs. no KP, p=0.0002). At listing and at transplant, there was no difference in mean weight, total bilirubin (TB), albumin, INR, ascites, or calculated PELD score.

The mean time on wait list was similar (119 vs. 152 days), as was the proportion requiring ICU admission before transplant (12% vs. 12%) and wait-list mortality (5% vs. 4%). Transplants rates were similar in both groups (87% vs. 86%), but subjects in the failed KP group were more likely to have a living donor LT (18% vs. 13%, p=0.02). The mean post-operative length of stay was similar between groups (26.5 vs. 25.3 days), as were graft and patient survival.

Discussion

Though differences were present based on ethnicity, the failed KP and no KP groups had similar pre- and post-operative courses. These results suggest that there is no added risk of attempting the KP, even in older infants with compensated disease who are less likely to benefit.

CITATION INFORMATION: Miloh T., Hosek K., Harpavath S. Comparison of No Kasai Portoenterstomy to Failed Kasai: Analysis of UNOS Database Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress