Prognostic Outcomes by Ishak Fibrosis Score Grouping in Biliary Atresia After Kasai Surgery.

OBJECTIVE

This study aimed to assess the native liver survival (NLS) of biliary atresia (BA) patients with varying Ishak scores post Kasai portoenterostomy (KPE).

METHODS

A prospective cohort study analyzed 83 BA patients who underwent KPE. Patients were stratified into Mild Fibrosis Group (Ishak 1-2, n=20), Moderate Fibrosis Group (Ishak 3-4, n=39), and Cirrhosis Group (Ishak 5-6, n=24) based on postoperative Ishak scores. At the 6-month postoperative follow-up, clinical characteristics and liver function test outcomes were compared between groups to evaluate postoperative recovery profiles.

RESULTS

Generalized estimating equations (GEE) revealed time-dependent declines in ALT, AST, ALP, and Total Bile Acid (TBA) across groups (P<0.05), with cirrhosis patients exhibiting higher GGT and bilirubin levels vs. mild fibrosis (P<0.05). 6-month Clearance of Jaundice (CoJ) differed significantly: 55.0% (mild) vs. 38.5% (moderate) vs. 8.3% (cirrhosis) (P=0.003). Six-month NLS sharply declined with fibrosis severity: 80.0% (mild) vs. 16.7% (cirrhosis) (P<0.001). Multivariate logistic regression identified lower Ishak scores and younger surgical age as independent predictors of survival (P<0.05).

CONCLUSION

KPE improved liver function, but the Cirrhosis Group had poorer outcomes. Hepatic fibrosis severity correlated negatively with NLS, highlighting the importance of early surgery.