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

Abstract

Introduction:

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

Materials and Methods:

We performed a retrospective review of all KPEs done in our institution from 2013 to 2023, focusing on pertinent clinical and histologic features. Patients were categorized into having favorable or unfavorable outcomes based on a 3-month post-operative serum total bilirubin (≥2 mg/dL) or mortality.

Results:

Of the 71 patients who underwent KPE during this period, 41 had liver biopsies available for review. Fibrosis, ductular reaction, and portal tract cellular infiltrates were consistently present in all samples examined, with varying degrees of giant cell transformation, portal tract edema, and ductal plate malformation. An elevated AST to Platelet Ratio Index (APRI) was linked to poorer prognosis, while visible bile plugs in biopsies significantly correlated with unfavorable outcomes.

Conclusions:

This study demonstrated the extensive variability of clinical and histologic features in biliary atresia. Identifying significant laboratory and histologic predictors of liver survival is essential in management and prognostication, especially in resource-limited settings where liver transplantation is not readily available.