DOES EARLY SUCCESSFUL KASAI LEADS TO BETTER TRANSPLANT FREE SURVIVAL?.

Alizai, N.; Vecchione, S.; Rajwal, S.; Mtegha, M.; Karthikeyan, P.; Jayaprakash, K.; Dawrant, M.; Matcovici, M.; Stephenson, J.

DOES EARLY SUCCESSFUL KASAI LEADS TO BETTER TRANSPLANT FREE SURVIVAL?.

All Authors

Alizai, N.

Vecchione, S.

Rajwal, S.

Mtegha, M.

Karthikeyan, P.

Jayaprakash, K.

Dawrant, M.

Matcovici, M.

Stephenson, J.

LTHT Author

Alizai, Naved
Vecchione, Sarah
Rajwal, Sanjay
Mtegha, Marumbo
Karthikeyan, Palaniswamy
Jayaprakash, Kavitha
Dawrant, Michael
Matcovici, Melania

LTHT Department

Leeds Children's Hospital
Children's Liver Unit
Paediatric Surgery

Publication Date

2025

Item Type

Conference Abstract

Abstract

Biliary Atresia (BA) is managed by Kasai Portoenterostomy (KPE) and or a Liver Transplantation (LT). There is evidence and acceptance of the fact that KPE performed at a younger age provides better jaundice clearance. It is also accepted that if KPE does not work LT will be required within 1 yr, in most cases. However, it has not been shown if there is a difference in the need and timing of LT in children who clear jaundice after undergoing an early successful KPE compared to those who undergo successful KPE at a late stage. We would like to present this aspect of our findings. We conducted a retrospective study on prospectively collected data between 2004 and 2023, with follow-up to 2024. Total number of patients were 210. Group 1 (KPE by day 30) n-51. Group 2 (KPE after 30 days of life) n-159. Gp 1 n-35 (68.62%) cleared jaundice and n-16 did not, compared to Gp 2, n-97 (61%) cleared jaundice while n-62 did not. Amongst the patients who cleared jaundice in Gp 1, n-5 (14.7%) required LT. Mean time to transplant was 69.6 months (range 15 to 185.3 months). There were no deaths. In Gp 2, n-2 patients died and n-19 (19.58%) have required LT. Mean time to transplant was 47 months (range 6 months to 147 months). Conclusion Patients undergoing KPE in the first month of life have a better rate of Jaundice clearance. Children undergoing early successful KPE are less likely to need a subsequent transplant than those who have a late successful KPE. Children undergoing early successful KPE requiring a LT are likely to need LT later than children who have a late successful KPE. Preliminary analysis on a data set including both children, who did and did not clear jaundice revealed that duration of survival to death or transplant in children with BA who had late KPE is reduced to about 38% of BA children undergoing early KPE. This result is statistically significant.