A scoring system to predict the need for liver transplantation for biliary atresia after Kasai portoenterostomy |
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Authors: | Jiang Chuen-Bin Lee Hung-Chang Yeung Chun-Yan Sheu Jin-Cherng Chang Pei-Yeh Wang Nien-Lu Yeh Ching-Yin |
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Affiliation: | (1) Department of Paediatrics, Mackay Memorial Hospital, 92, Section 2 Chung San North Road, 104 Taipei , Taiwan;(2) Department of Paediatric Surgery, Mackay Memorial Hospital, Taipei, Taiwan;(3) Department of Paediatrics, Taipei Medical University, Taipei, Taiwan;(4) Graduate Institute of Public Health, College of Public Health and Nutrition Science, Taipei Medical University, Taipei, Taiwan |
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Abstract: | A retrospective analysis was performed of the records of 133 patients with extrahepatic biliary atresia (EHBA) who had undergone a Kasai portoenterostomy. The patients were divided into a non-transplantation group who survived but did not receive liver transplantation after the procedure and a failure group of those who died or received liver transplantation. A score was calculated that assessed nine factors, including laboratory values and complications. The data were assessed at the time complications occurred. The scores were analysed by a trend analysis to see if serial scores predicted the evolution of liver disease. A receiver operating characteristic (ROC) curve was plotted to assess the optimal cut-point for the scoring system. There were 98 patients in the non-transplantation group and 35 in the failure group. The latter group had significantly higher post-operative bilirubin (9.3±7.2 mg/dl versus 3.5±3.1 mg/dl), ALT (136±89 U/l versus 92±88 U/l), prothrombin time, and incidence of cirrhosis, ascites, oesophageal varices, portal hypertension, cholangitis and sepsis than the non-transplantation group ( P <0.05). A score of 8 had a high sensitivity (96.9%) and specificity (89.5%) for predicting the need for liver transplant. Conclusion:based on easily available clinical information, our scoring system can predict which patients with biliary atresia who have already undergone a Kasai procedure should be considered for liver transplantation.Abbreviations EHBA extrahepatic biliary atresia - ROC receiver operating characteristic |
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Keywords: | Biliary atresia Kasai portoenterostomy Liver transplantation Scoring system |
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