Combined predictors of the long-term Kasai surgery outcomes in infants with biliary atresia

Purpose: Hepatic portoenterostomy (Kasai surgery) is widely used as the first-line treatment in infants with biliary atresia. Its long-term efficacy is undermined by the profound hepatotoxic damage already in place by the moment of the intervention.This retrospective study aimed at identification and validation of candidate clinical and biochemical markers with regard to long-term Kasai surgery outcomes using logistic regression models. Methods: : The retrospective study enrolled 166 infants with biliary atresia subject to Kasai procedure between September 2002 and December 2021. The patients were distributed into two groups depending on long-term surgery outcomes. Descriptive statistics was applied for between-the-group comparison of clinical and laboratory parameters recorded at the time of surgery. The candidate predictors were validated by logistic regression method involving the receiver operating characteristic (ROC) curve analysis. Results: : A logistic regression model involving total blood cholesterol and direct bilirubin levels on day 14 after surgery and Desmet score of fibrosis at surgery was estimated to account for 47.3% of the factors that determine the variance of favorable outcome probability. Conclusion: The results implicate blood cholesterol levels below 5.41 mmol/L and direct bilirubin levels below 56.3 µmol/L measured on postoperative day 14±3 as favorable predictors.