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J Hepatol. 2013 Jun;58(6):1209-17. doi: 10.1016/j.jhep.2013.01.040. Epub 2013 Feb 8.

Improving outcomes of biliary atresia: French national series 1986-2009.

Author information

1
Observatoire français de l'atrésie des voies biliaires, Hôpital Necker - Enfants malades, Université Paris Descartes, Paris, France. christophe.chardot@nck.aphp.fr

Abstract

BACKGROUND & AIMS:

This study analyses the prognosis of biliary atresia (BA) in France since liver transplantation (LT) became widely available.

METHODS:

The charts of all BA patients living in France and born between 1986 and 2009 were reviewed. Patients were divided into 3 cohorts according to their years of birth: 1986-1996, 1997-2002, and 2003-2009.

RESULTS:

1107 BA children were identified, 990 born in metropolitan France (incidence 1/18,400 live births). Kasai operation was performed in 1044 (94%), leading to complete clearance of jaundice (total serum bilirubin ≤ 20 μmol/L) in 38% of patients. Survival with native liver (SNL) after Kasai operation was 40%, 36%, and 30% at 5, 10, and 20 years, stable in the 3 cohorts. Median age at Kasai operation was 59 days, unchanged over time. Twenty-year SNL was 39%, 32%, 28%, and 19% after Kasai operation performed in the first, second, third months of life or thereafter (p=0.0002). 588 children underwent 692 LTs. Mortality without transplantation decreased over time: 16%, 7%, and 4% in the 3 cohorts (p<0.0001). Survival after transplantation was 83%, 82%, and 77% at 5, 10, and 20 years in the whole series. Five-year post-transplant survival was 75%, 90%, and 89% in the 3 cohorts (p<0.0001). In the whole series, overall BA patient survival was 81%, 80%, and 77% at 5, 10, and 20 years. Five-year BA patient overall survival increased over time: 72%, 88%, and 89% in the 3 cohorts (p<0.0001).

CONCLUSIONS:

BA patients currently have an 89% live expectancy, and a 30% chance to reach adulthood without transplantation. Early Kasai operation, without age threshold, reduces the need for liver transplantation until adulthood.

PMID:
23402746
DOI:
10.1016/j.jhep.2013.01.040
[Indexed for MEDLINE]

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