Aim of the study
To assess perioperative complications after Kasai hepatoportoenterostomy (HPE) in patients with biliary atresia (BA) in order to identify correlations with patient characteristics and survival with native liver (SNL, i.e. time until liver transplantation or death).
Patients enrolled in the National Biliary Atresia Registry who underwent HPE were studied (REB n° PB_2017-00531). The following data were analyzed: patient characteristics, perioperative complications and SNL. Perioperative complications were defined as complications arising during HPE and up to 30 days postoperatively, and were stratified in 1) surgical and 2) medical complications. The Spearman rank correlation coefficient was used to determine the association between (i) patient characteristics (gestational age at birth, age and weight at HPE, syndromic BA) and complications, and (ii) complications and SNL. SNL was analyzed using Kaplan-Meier plots.
87 BA patients underwent HPE between 1994 and 2017. 62 patients were included in the analysis (mean gestational age at birth 38+/-2 weeks, at HPE: mean age 62+/-21 days, mean weight 4504+/-974g). 26/62 patients (42%) had one or more complications: 19/62 (31%) had suspected or proven cholangitis; 6/62 (10%) had surgical perioperative complications, while 24/62 (39%) had medical perioperative complications. Lower gestational age at birth correlated with the occurrence of more overall complications (p=0.02). Age and weight at HPE were not significantly correlated (p=0.77 and p=0.98, respectively), as was the syndromic form of BA (p=0.41). There was no significant difference in SNL between patients with and without perioperative complications (p=0.51).
HPE is often complicated by medical perioperative complications, predominantly cholangitis. Age, weight at HPE and syndromic BA do not correlate with complications, whereas lower gestational age at birth correlates with more overall complications. In this series perioperative complications do not have an impact on SNL.