Impact of follow-up liver biopsy on long-term outcomes post-Kasai procedure in patients with biliary atresia

Abstract Purpose Patients with biliary atresia (BA) suffer from progressive liver damage, even after successful Kasai portoenterostomy (KPE). The purpose of this study is to analyze the relevance of follow-up percutaneous liver biopsy (LBx) and long-term prognosis of patients with BA. Methods This study included patients with BA who were born between 1983 and 2005 and survived with their native liver until 10 years of age. Patient characteristics, laboratory data and Child–Pugh score at the time of LBx, and native-liver survival (NLS) and complication-free survival (CFS) in patients with mild (F0-F2) or severe fibrosis (F3, F4) on follow-up LBx were retrospectively analyzed. Results Forty-three patients were gathered in this study and the most recent LBx was performed at age 21.1 ± 2.9 years. Thirty-three patients had mild fibrosis and ten patients had severe fibrosis on follow-up LBx. Long-term NLS and CFS were significantly worse in patients with severe fibrosis. Among those patients, 18 patients had follow-up LBx between the ages of 6 and 12 years, and CFS were significantly worse in patients with severe fibrosis. Conclusions We found that patients with BA with severe liver fibrosis on follow-up LBx had worse long-term survival and a higher rate of progression of complications of BA.