Prognostic values of serum bilirubin at 7th day post-Kasai for survival with native livers in patients with biliary atresia

Sinobol Chusilp; Paiboon Sookpotarom; Kanokan Tepmalai; Prapapan Rajatapiti; Voranush Chongsrisawat; Yong Poovorawan; Paisarn Vejchapipat

doi:10.1007/s00383-016-3951-9

Prognostic values of serum bilirubin at 7th day post-Kasai for survival with native livers in patients with biliary atresia

Pediatr Surg Int. 2016 Oct;32(10):927-31. doi: 10.1007/s00383-016-3951-9. Epub 2016 Jul 30.

Authors

Sinobol Chusilp^{1

2}, Paiboon Sookpotarom^{1

3}, Kanokan Tepmalai^{1

4}, Prapapan Rajatapiti¹, Voranush Chongsrisawat⁵, Yong Poovorawan⁵, Paisarn Vejchapipat⁶

Affiliations

¹ Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Rama IV road, Patumwan, Bangkok, 10330, Thailand.
² Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
³ Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand.
⁴ Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
⁵ Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
⁶ Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Rama IV road, Patumwan, Bangkok, 10330, Thailand. paisarnv@gmail.com.

PMID: 27476151
DOI: 10.1007/s00383-016-3951-9

Abstract

Background: Biliary atresia (BA) is a serious liver disease with uncertain prognosis. The objective of this study was to investigate prognostic values of the >20 % decrease in serum total bilirubin (TB) at 7th day post-op regarding early outcome and 5-year survival with native liver in BA.

Methods: Biliary atresia patients undergoing Kasai operation between 2000 and 2014 were reviewed. The ratio of serum TB at 7th day post-op to pre-op TB levels (TB7/TB0) was calculated for every patient. TB7/TB0 ratio of <0.8 indicated the >20 % decrease in serum TB. At 6th month following Kasai operation, outcome of BA patients were categorized into good outcome (TB < 2 mg % or clinically jaundice free) and poor outcome (TB > 2 mg % or clinically jaundice). For outcome analysis, logistic regression was used. For survival analysis, Cox regression was applied.

Results: There were 133 BA patients (M:F = 68:65) undergoing Kasai operation. Median age at surgery was 79 days. BA patients with TB7/TB0 ratio of <0.8 were found in 38 %. Outcome at 6-month post-op could be evaluated in 126 patients (good: poor = 68:58). The 1-, 3- and 5-year survival rates with native livers were 85, 70 and 65 %, respectively. The median overall survival with native livers was 164 months. Median follow-up time was 87 months. Logistic regression showed that gender and age at operation were not significant factors impacting on early outcome (p > 0.05). However, TB7/TB0 ratio of <0.8 was an independent factor for good outcome (Odds ratio = 3.0, p = 0.006). Cox regression analysis demonstrated that 5-year survival rate was significantly correlated with TB7/TB0 ratio of <0.8 (HR = 0.46, 95 % CI 0.23-0.91, p = 0.025) and outcome at 6th month post-op (HR = 0.05, 95 % CI 0.01-0.15, p < 0.001).

Conclusions: The >20 % decrease in serum TB at 7th day post-Kasai is a predictor for good outcome. BA patients with TB7/TB0 of <0.8 had 5-year survival with native livers significantly higher than those with the ratio of >0.8.

Keywords: Biliary atresia; Kasai operation; Serum bilirubin; Survival rate.

MeSH terms

Biliary Atresia / surgery*
Bilirubin / blood*
Female
Humans
Infant
Infant, Newborn
Liver / surgery*
Male
Odds Ratio
Portoenterostomy, Hepatic / mortality
Postoperative Complications / blood*
Postoperative Period
Prognosis
Survival Analysis
Survival Rate
Treatment Outcome

Substances

Bilirubin