ArticleBJS open2023
Biliary drainage surgery before or after 3 months of life versus primary liver transplantation in children with biliary atresia: comparative cohort study.
Article in BJS open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 11 citations in OpenAlex.
- Differentiation of biliary atresia using a rapid point-of-care matrix metalloproteinase-7 assay: A multicenter diagnostic study.Hepatology communications · 2026Article
- Evaluating the role of Kasai portoenterostomy in biliary atresia older than 90 days.Pediatric surgery international · 2025Article
- Sequential treatment strategy for biliary atresia: Kasai hepatoportoenterostomy-liver transplantation: a single-center retrospective comparative cohort study.BMC pediatrics · 2025Article
- [Kasai-hepatoportoenterostomy for the treatment of biliary atresia - What is important?]Chirurgie (Heidelberg, Germany) · 2025Review
- Serum FGF19 combined with GGT and other biomarkers predicted native liver survival following Kasai portoenterostomy in early biliary atresia.Journal of gastroenterology · 2025Article
- The Effect of a Kasai Procedure on Liver Transplantation in Children with Biliary Atresia: A Cohort Study.Journal of clinical medicine · 2025Article
- Primary liver transplantationWorld journal of transplantation · 2024Article
- Cost-effectiveness analysis of liver transplantation in biliary atresia according to the severity of end-stage liver disease.BMC pediatrics · 2023Article
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Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEarly biliary drainage surgery (BDS; Kasai) is associated with longer transplant-free survival in biliary atresia. However, evidence is lacking on whether an age limit can be established at which liver transplantation should be performed as first-line treatment for children with a delayed diagnosis of biliary atresia. The aim of the current study was to compare the outcome of a large cohort of children with biliary atresia who underwent BDS after 90 days of life with those who underwent early BDS (before 90 days) and those who did not receive BDS and were directly referred for primary liver transplantation.
methodsAll patients with biliary atresia treated at Bicêtre, Paris-Saclay University Hospital between 1995 and 2017 were analysed in this STROBE-compliant study. Three groups were defined: BDS before 90 days of life (early BDS); BDS after 90 days of life (late BDS); and patients without BDS who were referred for primary liver transplantation (no BDS). Patient characteristics, overall survival, and native liver survival were compared.
resultsOf 424 children with biliary atresia, 69 patients (16 per cent) were older than 90 days when they underwent BDS. Twenty-five patients had no BDS and were referred for primary liver transplantation (6 per cent). The main reason for not performing BDS was manifest portal hypertension (18/25). Two- and 5-year transplant-free survival were significantly higher in patients with late BDS compared with no BDS (53.5 versus 12.0 per cent respectively for 2-year data and 30.4 versus 4.0 per cent respectively for 5-year data, P < 0.001). Five- and 10-year overall survival did not differ between early BDS (92 and 91 per cent respectively), late BDS (88 and 83 per cent respectively) and no BDS (80 and 80 per cent respectively, P = 0.061).
conclusionAge alone should not routinely be considered a contraindication to BDS in patients older than 90 days. Liver transplantation in infancy (less than 12 months) could be avoided in 88 per cent of cases with late diagnosis of biliary atresia and is delayed significantly even when BDS is performed after 3 months. Overall survival is at least equal to patients who are referred for primary liver transplantation.
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