The most reliable early predictors of outcome in patients with biliary atresia after Kasai's operation

J Pediatr Surg. 2013 Dec;48(12):2373-7. doi: 10.1016/j.jpedsurg.2013.08.009.


Background/purpose: The purpose of this study was to determine reliable predictors of outcome of biliary atresia (BA) after Kasai's operation.

Patients and methods: Fifty-four BA cases that underwent Kasai's operation at our institution over two decades were reviewed. The cases were divided into two groups: Group I: cases that required liver transplantation or died (n=30) and Group II: cases alive with the native liver. Serum levels of total bilirubin (TB), direct bilirubin (DB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) were measured sequentially after surgery. For cut-off determination, receiver operating characteristic (ROC) analysis was employed.

Results: Serum TB, DB, AST, and ALT in Group I were significantly higher than those in Group II at 1, 2, and 3 months after surgery (p<.05). The most reliable cut-offs determined by ROC analysis were DB of 0.7 mg/dl at 2 months (sensitivity; 93%, specificity; 75%) and AST of 94 IU/L at 2 months (sensitivity; 87%, specificity; 71%). The 54 cases were re-divided into three groups according to the cut-off values: group G (good) with DB and AST<cut-offs (n=16; Group I:II=1:15), group M (moderate) with DB or AST>cut-offs (n=9; Group I:II=4:5), and group P (poor) with DB and AST ≥ cut-offs (n=29; Group I:II=25:4). The 15-year survival rate in groups G, M, and P was 94%, 44%, and 22%, respectively (p<.001).

Conclusion: The combination of serum DB and AST at 2 months after Kasai's operation is a reliable predictor of long-term BA outcome.

Keywords: AST; Biliary atresia; Direct bilirubin; Predictor; Prognosis.

Publication types

  • Evaluation Study

MeSH terms

  • Alanine Transaminase / blood*
  • Aspartate Aminotransferases / blood*
  • Biliary Atresia / blood
  • Biliary Atresia / mortality
  • Biliary Atresia / surgery*
  • Bilirubin / blood*
  • Biomarkers / blood
  • Decision Support Techniques*
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant, Newborn
  • Kaplan-Meier Estimate
  • Liver Function Tests
  • Liver Transplantation
  • Portoenterostomy, Hepatic*
  • ROC Curve
  • Treatment Outcome
  • gamma-Glutamyltransferase / blood*


  • Biomarkers
  • gamma-Glutamyltransferase
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • Bilirubin