{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:34:41Z","timestamp":1769387681242,"version":"3.49.0"},"reference-count":17,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T00:00:00Z","timestamp":1619049600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPGN rep."],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Objectives:<\/jats:title><jats:p>Biliary atresia (BA) is a progressive fibrosing cholangiopathy of infancy, the most common cause of cholestatic jaundice in infants and the top indication for liver transplantation in children. Kasai portoenterostomy (KPE) when successful may delay the requirement for liver transplantation, which in the majority offers the only cure. Good outcomes demand early surgical intervention, appropriate management of liver cirrhosis, and in most cases, liver transplantation. These parameters were audited of children with BA treated at the Steve Biko Academic Hospital (SBAH) in Pretoria, South Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>All children with BA who were managed at SBAH between June 2007 and July 2018 were included. Parameters measured centered on patient demographics, timing of referral and surgical intervention, immediate and long\u2010term outcomes of surgery, and follow\u2010up management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Of 104 children treated, 94 (90%) were KPE naive. Only 23\/86 (26%) of children were referred before 60 days of life and 42\/86 (49%) after 120 days. Median time to surgical assessment and surgery was 4 (IQR 1\u201370) and 5 (IQR 1\u201327) days post presentation, respectively. The median age at KPE was 91 days (IQR 28\u2013165), with only 4\/41 (12%) of KPEs performed before 60 days of life. Of those with recorded outcomes, 12\/33 (36%) achieved resolution of jaundice. Only a third of the cohort were referred for transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p>Children with BA have poor outcomes in the public health sector in South Africa. Late referrals, delayed diagnostics, advanced age at KPE with low drainage rates, poor follow\u2013up, and low transplant rates account for low survival. Early referral to units offering expert intervention at all stages of care, including transplantation, would offer the best outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1097\/pg9.0000000000000073","type":"journal-article","created":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T03:09:29Z","timestamp":1619147369000},"source":"Crossref","is-referenced-by-count":7,"title":["Improving Poor Outcomes of Children With Biliary Atresia in South Africa by Early Referral to Centralized Units"],"prefix":"10.1002","volume":"2","author":[{"given":"Francisca","family":"van der Schyff","sequence":"first","affiliation":[{"name":"Department of Transplantation Wits Donald Gordon Medical Center University of Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberta J.","family":"Terblanche","sequence":"additional","affiliation":[{"name":"Department of Paediatrics School of Clinical Medicine Faculty of Health Sciences University of Pretoria Pretoria South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean F.","family":"Botha","sequence":"additional","affiliation":[{"name":"Department of Transplantation Wits Donald Gordon Medical Center University of Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,4,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2017.08.048"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.sempedsurg.2012.05.010"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.sempedsurg.2004.10.024"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0176275"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2013.08.007"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60946-6"},{"key":"e_1_2_11_8_1","first-page":"122","article-title":"Management of biliary atresia: experience in a single institute","volume":"30","author":"Tiao MM","year":"2007","journal-title":"Chang Gung Med J"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181638627"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.5152\/tjg.2017.16622"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e31817d80de"},{"key":"e_1_2_11_12_1","unstructured":"Statistics South Africa. Census 2011 [homepage on Internet] c2013. Available at:http:\/\/beta2.Statssa.gov.za\/. Accessed November 20 2020"},{"key":"e_1_2_11_13_1","unstructured":"Statistics South AfricaRecorded live births 2012 [homepage on Internet] c2013. Available at:http\/\/www.statsa.gov.za\/publications\/P0305\/P03052012.pdf. Accessed November 20 2020"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)03492-3"},{"key":"e_1_2_11_15_1","first-page":"12131","article-title":"Outcomes of Kasai hepatoportoenterostomy in children with biliary atresia in Johannesburg, South Africa","volume":"107","author":"De Maayer T","year":"2017","journal-title":"S Afr Med J"},{"key":"e_1_2_11_16_1","first-page":"59","article-title":"Canadian Pediatric Hepatology Research GroupBiliary atresia: the Canadian experience","volume":"1516","author":"Schreiber RA","year":"2007","journal-title":"J Pediatr"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13569"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13232"}],"container-title":["JPGN Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1097\/PG9.0000000000000073","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T14:31:39Z","timestamp":1749738699000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1097\/PG9.0000000000000073"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,22]]},"references-count":17,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1097\/PG9.0000000000000073"],"URL":"https:\/\/doi.org\/10.1097\/pg9.0000000000000073","archive":["Portico"],"relation":{},"ISSN":["2691-171X","2691-171X"],"issn-type":[{"value":"2691-171X","type":"print"},{"value":"2691-171X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,22]]},"article-number":"e073"}}