Portal plate bile duct diameter in biliary atresia is associated with long-term outcome

Michael Shpoliansky, Ana Tobar, Yael Mozer-Glassberg, Michal Rosenfeld Bar-Lev, Raanan Shamir, Michal Shafir, Michael Gurevich, Orith Waisbourd-Zinman

Research output: Contribution to journalArticlepeer-review


Purpose: Kasai portoenterostomy (KPE) is the only treatment currently available for biliary atresia (BA). Age at KPE and surgical experience are prognostic factors for a successful KPE. Here, we aimed to assess whether the size of bile ductules at the porta hepatis during KPE correlates with KPE success and transplant-free survival (TFS). Methods: A retrospective analysis of patients diagnosed with BA during 2000–2019. Porta hepatis biopsies were reviewed for diameters of five representative ducts, and a mean ductal diameter (MDD) was calculated. Laboratory values including pre- and postoperative bilirubin levels were analyzed. Results: The cohort included 77 patients; for 33, ductal plate biopsy was available. KPE was successful in six of eight patients with MDD ≥ 50 µm, and in five of 25 with MDD < 50 µm, p = 0.008, OR = 12.0 (95% CI 1.83–78.3). Ten-year survival with native liver was higher in patients with MDD ≥ 50 µm than in patients with MDD < 50 µm, p < 0.001, HR 0.038 (95% CI 0.007–0.207). Direct bilirubin < 1 mg/dl 3 months post-KPE was associated with improved 2-year post-KPE TFS (27.7% vs. 13.9%, p < 0.0001). Conclusions: MDD ≥ 50 µm correlates with KPE success and a higher rate of TFS. Direct bilirubin < 1 mg/dl 3 months post-operation may serve as a marker of successful biliary excretion, and a predictor of 2-year TFS.

Original languageEnglish
Pages (from-to)825-831
Number of pages7
JournalPediatric Surgery International
Issue number6
StatePublished - Jun 2022


  • Bile duct
  • Biliary atresia
  • Kasai portoenterostomy
  • Native liver
  • Survival

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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