Risk Factors, Physicians’ Practice and Outcomes of Post-Kasai Cholangitis

Abstract Background Extra hepatic biliary atresia (EHBA) is the most common cause of neonatal cholestasis. Kasai operation is the only treatment of EHBA, however, several pre-and post-operative risk factors, with post-operative ascending cholangitis being the most common, can affect the outcome. Aim To investigate the effects of pre- and post-operative risk factors on the outcome of Kasai operation. The impact of the knowledge and practice of the treating physicians towards ascending cholangitis will be also assessed. Methods This was a retrospective cohort study that was conducted at the Hepatology clinic, Children’s Hospital, Ain Shams University. The required data was collected from 45 patients’ medical records with confirmed EHBA and who underwent Kasai operation including the most common pre-operative and postoperative risk factors of post-Kasai cholangitis (age at operation, weight, hepatosplenomegaly, liver cirrhosis, complete liver function tests and abdominal ultrasound). An online questionnaire using google forms about the diagnosis and treatment of cholangitis was distributed to the treating physicians. Results Patients with EHBA included 20 males and 25 females. Kasai procedure has achieved initial success in 31.1% of patients. Twenty-seven patients (60%) developed post-Kasai cholangitis. Eighteen patients (66.7%) developed early-onset cholangitis; 9 patients (33.3%) developed late-onset cholangitis. The mortality rate was 25.9% among the cholangitic patients. Although most of the cholangitic group had a high APRI Score (Aspartate Aminotransferase to Platelet Ratio Index) one- year post-operative more than 1, yet it wasn’t statistically significant. Pre-operative AST was significantly higher (p = 0.014) in the early-cholangitic group. Postoperative one-year follow up compared to pre-operative duration showed that ALT (p = 0.016), AST (p = 0.002), GGT (p < 0.001), and albumin (p = 0.003) were significantly decreased in the cholangitic group. Regarding the early-cholangitic group weight (p = 0.027), ALT (p = 0.0038), AST (p = 0.024), GGT (p < 0.001), and albumin (p = 0.004) were significantly decreased, while in the late-cholangitic group GGT was significantly decreased (p = 0.029). The participant physicians were 88 general pediatricians and 13 pediatric surgeons. More than 75% of the participants gave the correct answers for the antibiotic use and 50 % only responded correctly to questions about the duration of prophylactic and therapeutic antibiotics. Conclusion Post-Kasai cholangitis had a bad prognosis which was associated with high mortality rate. Most of the cholangitic patients had a high APRI Score more than 1 one-year post-operative indicating liver cirrhosis. Pre-operative AST is considered a risk factor of early cholangitis. Limited knowledge and practice of the treating physicians were detected regarding post-Kasai cholangitis.