ArticlePediatric surgery international2026
Dynamic landmark models predicting native liver survival after kasai portoenterostomy: a bicentric study.
Article in Pediatric surgery international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesNative liver survival (NLS) after Kasai portoenterostomy (KPE) for biliary atresia (BA) is highly heterogeneous, and clinically practical approaches that update prognostic estimates across prespecified postoperative follow-up time points remain limited.
methodsIn this retrospective bicentric cohort study (training, n = 168; validation, n = 80), Cox proportional hazards landmark models were developed at five prespecified time points (preoperative and 2 weeks, 1, 3, and 6 months post-KPE) using a LASSO/Boruta dual-algorithm intersection approach with variance inflation factor (VIF)-based collinearity pruning. Internal validation used 500-replicate bootstrap resampling; external validation was performed in an independent cohort.
resultsPreoperative and 2-week models showed limited discrimination (C-index ≤0.576). The 3-month two-variable model (TBA + TBil clearance ratio [TBil-CR]) achieved a training C-index of 0.812 (optimism 0.003) and an external C-index of 0.778 (95% CI 0.679-0.878). Risk stratification yielded a 35-percentage-point difference in 2-year cumulative event rates (41.7% vs. 7.0%; log-rank P < 0.001), consistently reproduced in the validation cohort. TBil-CR HR declined progressively across postoperative landmarks, and its single-variable C-index exceeded the jaundice clearance criterion by 0.103 at 3 months.
conclusionsA parsimonious two-variable landmark model incorporating TBil-CR and TBA at 3 months post-KPE accurately predicts long-term NLS in children with BA, outperforming traditional binary bilirubin thresholds.
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