Late Referral of Biliary Atresia and Poor Clinical Outcomes.

BACKGROUND/AIMS: Biliary atresia (BA) is a progressive cholangiopathy in infants that often necessitates liver transplantation. This study aimed to evaluate the impact of delayed referral on clinical and histopathological outcomes in BA cases.

METHODS

This study was a prospective observational study conducted from January to September 2023 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

RESULTS

A total of 137 infants with cholestasis were enrolled. Of these, only 85 underwent liver biopsy, with 60 cases (70.6%) confirmed as extrahepatic cholestasis consistent with BA. Among these 60 BA-confirmed patients, 83.3% were referred after 60 days of age. Patients in the late referral group (>60 days) in all cases exhibited higher leukocyte counts, total bilirubin levels, prolonged prothrombin time, and hypoalbuminemia, reflecting a more advanced disease state. Two-phase ultrasonography detected abnormalities in 76.7% of BA-confirmed cases, supporting its potential role as a screening modality in resource-limited settings. Histopathological analysis revealed a significantly higher prevalence of liver fibrosis in patients referred after 60 days (p=0.002), indicating disease progression. Only 9 patients underwent Kasai portoenterostomy, with 8 fatalities due to ascending cholangitis.

CONCLUSIONS

These findings emphasize the urgent need for earlier detection and referral to improve outcomes in infants with BA.