Cytomegalovirus infection impact on cholangitis in patients with biliary atresia following the Kasai procedure

Introduction: Biliary atresia (BA) is a congenital anomaly often found in neonates, with an incidence reaching 1:5500 per birth. BA is frequently associated with cytomegalovirus (CMV) infection in the patient, which causes a clinical appearance different from other types of BA. BA is usually treated by Kasai procedure, with cholangitis being the most common complication of this procedure. CMV infection is found to affect post-operative survival and bilirubin levels. However, it remains unclear whether the infection may affect the incidence of cholangitis in BA patients post-Kasai procedure. Materials and Methods: This retrospective study used the medical records of 33 BA patients who underwent the Kasai procedure in Dr. Sardjito Hospital between 2017 and 2021. Results: Among 33 patients, 17 (51.5) were infected with CMV, and 12 (36.4) developed cholangitis. The frequency of cholangitis following the Kasai procedure is not significantly influenced by the CMV infection (p=0.615). Interestingly, the incidence of cholangitis is significantly associated with the pre-operative gamma-glutamyl transferase (GGT) levels (p=0.026). Furthermore, preoperative ALP appears to have a protective effect against cholangitis, with these associations nearly reaching a significant level (p=0.093). Conclusion: CMV infection is unlikely to impact the incidence of cholangitis after the Kasai procedure in BA patients. Notably, the pre-operative GGT level might affect the incidence of cholangitis following the Kasai procedure, thereby increasing their risk. © 2025, Malaysian Medical Association. All rights reserved.