Ann Surg Treat Res.  2025 Feb;108(2):93-97. 10.4174/astr.2025.108.2.93.

The characteristics of patients who failed initial Kasai portoenterostomy and the long-term prognosis of those who underwent redo-Kasai: a retrospective observational study

• Ha S
• Gang S
• Park J
• Kwon H
• Kim DY
• Kim SC
• Namgoong JM

• KMID: 2564248
• DOI: http://doi.org/10.4174/astr.2025.108.2.93

Abstract

Purpose
The purpose of this study was to determine the characteristics of patients with failed initial Kasai portoenterostomy (KP) and to compare the long-term prognosis of redo-KP with that of liver transplantation (LT) in these patients.
Methods
The medical records of patients with biliary atresia (BA) who failed initial KP from 2010 to 2021 at a single center were retrospectively analyzed. KP failure was defined as persistent jaundice (total bilirubin concentration, ≥2.0 mg/dL) after KP or the performance of LT.
Results
During the study period, 32 patients experienced initial KP failure, with 10 undergoing redo-KP and 22 undergoing LT. Redo-KP was successful in a minority of patients with failed initial KP, but the complications, particularly cholangitis, were more frequent in the redo-KP group. The long-term prognosis of redo-KP compared to LT showed that while some patients benefited from native liver survival after redo-KP, LT remains the more definitive solution for sustained liver function and survival in patients with BA.
Conclusion
The only factor differing significantly between patients who underwent redo-KP and LT after failed initial KP was complications of cholangitis. Redo-KP was successful in 4 of 10 patients with failed initial KP, suggesting that redo-KP may be a treatment option in patients with BA and failed initial KP.

Keyword

Biliary atresia; Morbidity; Portoenterostomy

Figure

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  Fig. 1 Flowchart of patients who underwent Kasai portoenterostomy (KP) at our institution during the study period. LT, liver transplantation.

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  Fig. 2 Kaplan-Meier analysis of overall native liver survival after initial Kasai portoenterostomy of patients with biliary atresia at Asan Medical Center.

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