Does time taken to achieve jaundice-clearance influence survival of the native liver in post-Kasai biliary atresia?

Background We reviewed the time taken for post-portoenterostomy(PE)biliary atresia(BA)patients to obtain jaundice-clearance(total bilirubin≤1.2 mg/dL;JC)post-PE to determine if JC time(JCT)is prognostic for survival of the native liver(SNL).Methods The subjects were 66 BA patients treated with PE at our institute between 1989,the year when liver transplan-tation(LTx)became available in Japan,and 2014.JCT was used to create three groups(≤30 days:n=14;31-60 days:n=31;≥61 days:n=21).Medical records were reviewed retrospectively to evaluate:age at onset of symptoms,duration of symptoms pre-PE,age and weight at PE,serum liver function tests,incidence of cholangitis,and micro-bile duct size at PE.Results Age at onset of symptoms,age and weight at PE,duration of symptoms pre-PE,and micro-bile duct size were similar for all patients in all three groups.JCT and SNL appeared to correlate because preoperative total bilirubin(7.1,9.6,10.2 mg/dL;P<0.05)was significantly lower in the JCT≤30 days group(P<0.05)while there was a significant decrease in SNL(P<0.03)and a significant increase in LTx(P<0.01)in the JCT≥61 days group.All LTx subjects who achieved JC were found to have developed cholangitis within 3 months of PE.Conclusion During the follow-up of post-PE subjects,longer JCT and cholangitis occurrence within 3 months of PE would appear to be negative prognostic factors for SNL while preoperative total bilirubin would appear to be a positive prognostic factor for SNL.