{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T21:27:10Z","timestamp":1783978030209,"version":"3.55.0"},"reference-count":32,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Introduction\u2003The majority of pediatric surgeons and hepatologists recommend the centralization of biliary atresia (BA) treatment within experienced liver units. We aimed to investigate whether voluntary self-restriction and acceptance of the need for this change in practice changed the BA referral policy in Germany during the last decade.<\/jats:p><jats:p>Materials and Methods\u2003In cooperation with pediatric surgeons, gastroenterologists or hepatologists, and pediatric liver transplant units, the 2-year follow-up data of infants with BA born in Germany between 2010 and 2014 were collected using www.bard-online.com or pseudonymized data transfer. Results were compared with our previous analysis of the outcome data of infants with BA born between 2001 and 2005 in Germany.<\/jats:p><jats:p>Result\u2003Overall, 173 infants with BA were identified, of whom 160 underwent Kasai portoenterostomy (KPE; 92.5%) and 13 (7.5%) underwent primary liver transplantation at 21 German centers. At 2-year follow-up, overall survival was 87.7% (vs. 81.9% in 2001\u20132005 [p\u2009=\u20090.19]), survival with native liver post-KPE was 29.2% (vs. 22.8% in 2001\u20132005 [p\u2009=\u20090.24]), and jaundice-free survival with native liver post-KPE was 24.0% (vs. 20.1% in 2001\u20132005 [p\u2009=\u20090.5]). Compared with the 2001\u20132005 analysis, all criteria showed improvement but the differences are statistically not significant.<\/jats:p><jats:p>Conclusion\u2003Our observation shows that KPE management requires improvement in Germany. Centralization of BA patients to German reference liver units is not yet mandatory. However, European and national efforts with regard to the centralization of rare diseases support our common endeavor in this direction.<\/jats:p>","DOI":"10.1055\/s-0041-1723994","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T23:40:21Z","timestamp":1614901221000},"page":"233-239","source":"Crossref","is-referenced-by-count":21,"title":["Centralization of Biliary Atresia: Has Germany Learned Its Lessons?"],"prefix":"10.1055","volume":"32","author":[{"given":"Omid","family":"Madadi-Sanjani","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Fortmann","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1268-6092","authenticated-orcid":false,"given":"Udo","family":"Rolle","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Urology, Goethe University Frankfurt \/M., Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkhard","family":"Rodeck","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology, Christliches Kinderhospital Osnabrueck, Osnabrueck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekkehard","family":"Sturm","sequence":"additional","affiliation":[{"name":"Department of Paediatric Gastroenterology and Hepatology, University Hospital for Children and Adolescents, University of Tuebingen, Baden-W\u00fcrttemberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva-Doreen","family":"Pfister","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim F.","family":"Kuebler","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Baumann","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany"},{"name":"Liver Unit, Birmingham Women\u2019s and Children\u2019s Hospital, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Schmittenbecher","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Municipal Hospital, Karlsruhe, Baden-Wuerttemberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/1750-1172-8-128","article-title":"Aetiology of biliary atresia: what is actually known?","volume":"8","author":"C Petersen","year":"2013","journal-title":"Orphanet J Rare Dis"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1038\/nrgastro.2015.74","article-title":"Pathogenesis of biliary atresia: defining biology to understand clinical phenotypes","volume":"12","author":"A Asai","year":"2015","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s40139-018-0181-y","article-title":"Perioperative developments in biliary atresia treatment","volume":"6","author":"O Madadi-Sanjani","year":"2018","journal-title":"Curr Pathobiol Rep"},{"issue":"12","key":"ref4","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1007\/s00383-017-4157-5","article-title":"Adjuvant therapy in biliary atresia: hopelessly optimistic or potential for change?","volume":"33","author":"M Davenport","year":"2017","journal-title":"Pediatr Surg Int"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1055\/s-0038-1668146","article-title":"What happens after Kasai for biliary atresia? 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