Outcomes of biliary atresia in the Nordic countries - a multicenter study of 158 patients during 2005-2016

Research output: Contribution to journalArticle

Abstract

Background/purpose: Biliary atresia is the most common reason for newborn cholestasis and pediatric liver transplantation. Even after normalization of serum bilirubin after portoenterostomy, most patients require liver transplantation by adulthood due to expanding fibrosis. We addressed contemporary outcomes of biliary atresia in the Nordic countries. Methods: Data on center and patients characteristics, diagnostic practices, surgical treatment, adjuvant medical therapy after portoenterostomy, follow-up and outcomes were collected from all the Nordic centers involved with biliary atresia care during 2005-2016. Results: Of the 154 patients, 148 underwent portoenterostomy mostly by assigned surgical teams at median age of 64 (interquartile range 37-79) days, and 95 patients (64%) normalized their serum bilirubin concentration while living with native liver. Postoperative adjuvant medical therapy, including steroids, ursodeoxycholic acid and antibiotics was given to 137 (93%) patients. Clearance of jaundice associated with young age at surgery and favorable anatomic type of biliary atresia, whereas annual center caseload >. 3 patients and diagnostic protocol without routine liver biopsy predicted early performance of portoenterostomy. The cumulative 5-year native liver and overall survival estimate was 53% (95% CI 45-62) and 88% (95% CI 83-94), respectively. Portoenterostomy age <. 65. days and annual center caseload >. 3 patients were predictive for long-term native liver survival, while normalization of serum bilirubin after portoenterostomy was the major predictor of both native liver and overall 5-year survival. Conclusions: The outcomes of biliary atresia in the Nordic countries compared well with previous European studies. Further improvement should be pursued by active measures to reduce patient age at portoenterostomy. Retrospective prognosis study: Level II.

Details

Authors
  • Mikko P Pakarinen
  • Lars Søndergaard Johansen
  • Jan F. Svensson
  • Kristin Bjørnland
  • Vladimir Gatzinsky
  • Pernilla Stenström
  • Antti Koivusalo
  • Nina Kvist
  • Markus Almström
  • Ragnhild Emblem
  • Sigurdur Björnsson
  • Torbjörn Backman
  • Runar Almaas
  • Hannu Jalanko
  • Björn Fischler
  • Jørgen Thorup
  • Nordic Pediatric Surgery Study Consortium
Organisations
External organisations
  • Helsinki University Central Hospital
  • Copenhagen University Hospital
  • Karolinska University Hospital
  • Oslo university hospital
  • Queen Silvia Children’s Hospital
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Surgery

Keywords

  • Clearance of jaundice, Liver transplantation, Portoenterostomy, Steroids, Survival, Ursodeoxycholic acid
Original languageEnglish
Pages (from-to)1509-1515
JournalJournal of Pediatric Surgery
Volume53
Issue number8
Early online date2017
Publication statusPublished - 2018
Publication categoryResearch
Peer-reviewedYes