To evaluate the effect of Kasai operation on the clinical efficacy of liver transplantation in children with biliary atresia (BA).

Clinical data of 105 children with BA who underwent liver transplantation in Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University from October 2013 to October 2020 were retrospectively analyzed. The informed consents of the patients' guardians were obtained and the local ethical committee approval was received. Among them, 61 children were male and 44 female, aged from 4 to 168 months old, with a median age of 8 months old. According to whether Kasai operation was performed before liver transplantation, the patients were divided into the Kasai group (n=51) and non-Kasai group (n=54). Preoperative general conditions, perioperative conditions and incidence of postoperative complications were compared between two groups. The children were followed up. The survival rate after liver transplantation was compared between two groups. Age, pediatric end-stage liver disease (PELD) score and the graft-to-recipient weight ratio (GRWR) between two groups were compared by rank-sum test or t test. The incidence of complications after liver transplantation between two groups was compared by Chi-square test. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

In the Kasai group, the age of children undergoing liver transplantation was 11(28) months, significantly older than 7(2) months in the non-Kasai group (Z=5.005,P<0.05). In the Kasai group, the PELD score was 8(22), significantly lower compared with 21(10) in the non-Kasai group (Z=-5.211,P<0.05). In the Kasai group, the GRWR was (3.0±0.9)%, significantly lower than (3.4±0.7)% in the non-Kasai group (t=-2.275,P<0.05). Total liver transplantation was adopted in 24%(12/51) of patients in the Kasai group, whereas living or split liver transplantation was performed in 94%(51/54) of patients in the non-Kasai group (χ²=8.443,P<0.05). The incidence of complications after liver transplantation in the Kasai group was 12%(6/51) and 17%(9/54) in the non-Kasai group with no significant difference between two groups (χ²=0.515,P>0.05). In the Kasai group, the 1-, 2-, 3- and 5-year survival rates after liver transplantation were 94.1%, 88.7%, 83.5% and 83.5%, and 92.6%, 90.4%, 87.9% and 78.1% in the non-Kasai group with no significant difference between two groups (χ²=0.001,P>0.05).

Kasai operation can effectively postpone the requirement of liver transplantation in BA children, improve the preoperative conditions, lower the risk and difficulty of liver transplantation, and yield equivalent survival rate compared with that of their counterparts undergoing immediate liver transplantation.