Approaches to the diagnosis and treatment of biliary atresia: cholangitis (A clinical study)
DOI:
https://doi.org/10.37800/RM.1.2026.547Keywords:
biliary atresia, Kasai portoenterostomy, Kasai procedure, liver transplantation, cholangitis, cholestasis, neonatal surgeryAbstract
Relevance: Biliary atresia (BA) is a progressive cholestatic disease of newborns, accompanied by obliteration of the bile ducts and the development of biliary cirrhosis. Despite the introduction of Kasai surgery (Kasai portoenterostomy, Kasai procedure) into clinical practice, the frequency of liver transplantation in atresia remains high (up to 80%). One of the most frequent and serious complications after Kasai portoenterostomy is cholangitis, as it affects the outcome of the disease and the timing of the need for liver transplantation.
This study aimed to summarize the current understanding of the diagnosis and treatment of biliary atresia in children, as well as to evaluate the clinical outcomes and incidence of cholangitis in patients who underwent Kasai portoenterostomy and liver transplantation, based on an analysis of their own observations.
Materials and Methods: The study included 100 patients with confirmed atresia who were observed in Kazakhstan from 2014 to 2024. The patients were divided into two groups: 50 patients after Kasai surgery and 50 patients after primary liver transplantation. Clinical and laboratory parameters, data from instrumental and morphological studies are analyzed. Statistical analysis methods (Mann-Whitney U-test, χ²-criterion, logistic regression, and ROC analysis) were used in SPSS and R.
Results: The average age at diagnosis was 72 days; 82% of patients showed signs of cirrhosis. The incidence of cholangitis after Kasai surgery was 64%, after transplantation, 22%. The statistical significance of the age at the time of surgery and the AST-to-platelet ratio index (APRI) has been established as predictive factors. Cholangitis has been associated with anastomotic strictures and infections.
Conclusion: The high incidence of cholangitis after Kasai portoenterostomy underscores the need for early diagnosis and a clear management route for patients with atresia. The use of prognostic markers and the development of a monitoring system make it possible to optimize treatment tactics.
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