Portosystemic shunt for portal hypertension after Kasai operation in patients with biliary atresia

Pediatr Surg Int. 2021 Jan;37(1):101-107. doi: 10.1007/s00383-020-04773-2. Epub 2020 Nov 17.

Abstract

Purpose: Many biliary atresia (BA) patients will eventually develop liver failure even after a successful Kasai portoenterostomy. A common complication of long-term BA survivors with their native liver is problematic portal hypertension. The aim of this study was to defend the view that portosystemic shunts can delay or negate the need for transplantation in these children.

Methods: A retrospective single center review of the efficacy of portosystemic shunts in BA patients after a successful Kasai portoenterostomy was conducted.

Results: From 1991 to 2017, 11 patients received portosystemic shunts. Median age of Kasai operation was 48 (36-61) days. Shunts were performed at the median age of 6.2 (4.1-6.8) years. Three of these eleven patients required subsequent liver transplantation. OS at 5 and 10 years were 90.9% and 81.8%, respectively. TFS at 5 and 10 years were 90.9% and 72.7%, respectively. Long-term complications included mild encephalopathy in 2 patients, hypersplenism in 3, and cholestasis in 1.

Conclusion: Portosystemic shunt for the treatment of portal hypertension in carefully selected BA patients is an effective option in delaying or negating the need for liver transplantation.

Keywords: Biliary atresia; Children; Esophageal varices; Liver transplant; Portal hypertension; Portosystemic shunt.

MeSH terms

  • Biliary Atresia / complications
  • Biliary Atresia / surgery*
  • Child, Preschool
  • Female
  • Humans
  • Hypertension, Portal / complications
  • Hypertension, Portal / surgery*
  • Male
  • Portasystemic Shunt, Transjugular Intrahepatic / methods*
  • Portoenterostomy, Hepatic / methods*
  • Postoperative Complications / surgery*
  • Retrospective Studies
  • Treatment Outcome