Early prediction of long-term survival and the timing of liver transplantation after the Kasai operation

Background/Purpose: The aim of this study was to determine early prognostic indicators for the prediction of long-term survival rate and timing of the liver transplantation after the Kasai operation. Methods: A retrospective chart study was performed on 142 patients with biliary atresia (BA). The patients were divided in a success and a failure group, according to whether the patients serum bilirubin levels returned to normal (less than 1.0 mg/dL) within 3 months. The differences in survival rates and performance status between the 2 groups were analyzed statistically. Results: The difference in cumulative survival rate between the 2 groups was striking. When the current status of the 40 patients who had survived for over 12 years was compared, 16 patients (53.3%) from the success group and 1 (9.1%) from the failure group had normal bilirubin levels, normal growth, no esophageal varix, and no hypersplenism. From the Kaplan-Meier survival curve, 3 types of deterioration were identified. Type 1 was death within 3 years. In type 2, deterioration occurred from 4 to 13 years. Type 3 was defined as unexpected deterioration in the success group, and its incidence was extremely low. Conclusions: Serum bilirubin level at 3 months after the Kasai operation can be used to predict long-term survival and the time when the onset of liver failure is likely to occur. Copyright (C) 2000 by W.B. Saunders Company.