Prognostic factors for five-year survival in children with biliary atresia after the Kasai procedure

Introduction: Biliary atresia (BA) is an idiopathic disease characterized by progressive fibro-obliteration of extra-and intrahepatic biliary ducts manifesting jaundice >2 weeks. The primary treatment for BA is the Kasai procedure. However, patient survival in BA is influenced by several prognostic factors. We aimed to identify the prognostic factors for 5-year survival of BA patients following the Kasai procedure at Dr. Sardjito Hospital, Yogyakarta, Indonesia. Materials and Methods: This observational analytic study employed a retrospective cohort design, included BA patients who underwent Kasai procedures at our hospital between January 2012 and December 2018. Results: There was no association between age at surgery (p=0.408), TB7 (p=0.973), operator experience (p=0.649), AST0 (p=0.973), AST7 (p=1), the AST7/AST0 ratio (p=0.682), ALT0 (p=0.682), ALT7 (p=0.697), and the ALT7/ALT0 ratio (p=1) with 5-year survival in BA patients after Kasai procedure. A log-rank analysis showed no significant results: age at surgery (p=0.264), TB7 (p=0.961), operator experience (p=0.479), AST0 (p=0.993), AST7 (p=0.931), AST7/AST0 ratio (p=0.562), ALT0 (p=0.708), ALT7 (p=0.640), and ALT7/ALT0 ratio (p=0.963). Conclusion: The timing of surgery, total bilirubin levels at 7 days post-surgery, surgeon experience, and both pre-and post-operative AST and ALT may not predict 5-year survival outcomes in BA patients following Kasai surgery. Further extensive cohort studies are necessary to confirm these preliminary findings. © 2025, Malaysian Medical Association. All rights reserved.