Histopathologic Features of Biliary Atresia and Outcome Predictors of Kasai Portoenterostomy: A 10-Year Retrospective Study of a Philippine Cohort

Objective: There is a dearth of information regarding the epidemiology of biliary atresia and outcomes of Kasai portoenterostomy (KPE) in the Philippines. We describe the histopathologic features of biliary atresia and identify outcome predictors of KPE in a local cohort.

Methodology This is a retrospective cohort study which reviewed all KPEs done in our institution from 2013 to 2023. Patients were categorized into having favorable or unfavorable outcomes based on a 3-month post-operative serum total bilirubin of more than 2 mg/dL or mortality at 3 months.

Results 71 patients underwent KPE, 41 of which had liver biopsies available for review. 28 had available outcomes. Fibrosis, ductular reaction, and portal tract cellular infiltrates were consistently present in all samples examined, with varying degrees of portal tract edema and giant cell transformation. High AST to Platelet Ratio Index pre-operatively was associated with a poorer prognosis. The presence of visible bile plugs in biopsy samples was the only histologic feature that had a significant correlation with the post-KPE outcome.

Conclusion: This study demonstrated the spectrum of histologic features in biliary atresia. Identifying significant laboratory and histologic features that can help predict native liver survival is essential in prognostication and in tailoring management goals post-KPE, especially in settings where liver transplant is not readily available.

Publication History

Article published online:
20 January 2025