Risk factors

The age of the child at the time when Kasai operation is performed is a modifiable factor which allows to improve the chance of success of portoenterostomy: the earlier the Kasai operation, the better the chance for the child to be alive with his/her native liver in adolescence. In a recent French study including hundreds of children with biliary atresia (Observatoire Français de l’Atrésie Biliaire (http://asso.orpha.net/OFAVB/), the median age at the time of the Kasai operation was 60 days. If the operation was performed in all children before the age of 45 days, the survival rate with the native liver would increase by 12% at the age of 15. This improvement would lead to a 6% reduction in the total number of pediatric liver transplants performed every year in France.

In Switzerland, a first national survey including all biliary atresia patients born between 1994 and 2004 showed that the median age at the time of portoenterostomy was 68 days, which is rather late according to international standards. Consequently, in order to improve the prognosis of biliary atresia patients, to reduce the need for liver transplant in children, and to save resources (graft scarcity, financial and human cost of transplantation), biliary atresia should be diagnosed earlier.