{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:29:33Z","timestamp":1790162973630,"version":"4.1.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T00:00:00Z","timestamp":1689120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82170528"],"award-info":[{"award-number":["82170528"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2018A030313570"],"award-info":[{"award-number":["2018A030313570"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To explore the outcomes and related factors in children without cholangitis after Kasai portoenterostomy (KPE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed the data of infants with type III BA who underwent KPE from June 2016 to December 2021. We compared and analyzed the difference in native liver survival (NLS) rates in different types of cholangitis. We also investigated the relationship between the absence of cholangitis and the effect of early bile drainage (EBD) as well as the related factors affecting EBD efficacy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 145 children were included in this study. Among these children, 82 (56.6%, 82\/145) had cholangitis, including 40 (48.8%, 40\/82) with early cholangitis and 33 (40.2%, 33\/82) with recurrent cholangitis. The median follow-up period was 29 months (range, 2\u201375 months). The NLS rates were 67.6%, 51.7%, 45.5% and 43.4% at 6 months, 1 year, 2 years and 5 years following KPE, while the NLS rates for infants without cholangitis after KPE were 68.3%, 50.8%, 46.0% and 46.0%, respectively. Higher gamma-glutamyl transferase (\u03b3- GT) and total bile acid (TBA) before KPE were risk factors for cholangitis (<jats:italic>P\u2009<\/jats:italic>&amp;lt;\u20090.05). The NLS rate in recurrent cholangitis was significantly lower than that in occasional cholangitis (<jats:italic>P\u2009<\/jats:italic>&amp;lt;\u20090.01). Compared with the EBD-poor group, the NLS rate in the EBD-good group of infants was significantly increased (<jats:italic>P\u2009<\/jats:italic>&amp;lt;\u20090.001). EBD was significantly correlated with the occurrence and frequency of cholangitis (<jats:italic>P\u2009<\/jats:italic>&amp;lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Recurrent cholangitis was an important factor affecting NLS. For children without cholangitis after KPE, early bile drainage was better, and the NLS was longer.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2023.1189792","type":"journal-article","created":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T21:19:11Z","timestamp":1689196751000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Early bile drainage improves native liver survival in biliary atresia without cholangitis"],"prefix":"10.3389","volume":"11","author":[{"given":"Fei","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaogang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zijian","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyuan","family":"Tao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menglong","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jixiao","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/j.amsu.2021.01.052","article-title":"Short- and long-term outcomes after Kasai operation for type III biliary atresia: twenty years of experience in a single tertiary Egyptian center-A retrospective cohort study","volume":"62","author":"Gad","year":"2021","journal-title":"Ann Med Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1007\/s00464-020-07530-7","article-title":"The short-term outcome of modified laparoscopic Kasai portoenterostomy for biliary atresia","volume":"35","author":"Ji","year":"2021","journal-title":"Surg Endosc"},{"key":"B3","doi-asserted-by":"publisher","first-page":"990101","DOI":"10.3389\/fsurg.2022.990101","article-title":"The composition of the gut microbiota is altered in biliary atresia with cholangitis","volume":"9","author":"Zheng","year":"2022","journal-title":"Front Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1007\/s12519-022-00619-0","article-title":"Biliatresone: progress in biliary atresia study","volume":"19","author":"Zhu","year":"2023","journal-title":"World J Pediatr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.jss.2020.06.019","article-title":"Drivers of hospital readmission and early liver transplant after Kasai portoenterostomy","volume":"256","author":"Ryon","year":"2020","journal-title":"J Surg Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2559","DOI":"10.1016\/j.jpedsurg.2019.08.026","article-title":"Risk factors and prognostic effects of cholangitis after Kasai procedure in biliary atresia patients: a retrospective clinical study","volume":"54","author":"Liu","year":"2019","journal-title":"J Pediatr Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"494","DOI":"10.3390\/jcm11030494","article-title":"Cholangitis definition and treatment after Kasai hepatoportoenterostomy for biliary atresia: a Delphi process and international expert panel","volume":"11","author":"Calinescu","year":"2022","journal-title":"J Clin Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2409","DOI":"10.1016\/j.jpedsurg.2018.08.028","article-title":"Does the identity of the bacteria matter in post-Kasai cholangitis? A comparison between simple and intractable cholangitis","volume":"53","author":"Chung","year":"2018","journal-title":"J Pediatr Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"3000605211012596","DOI":"10.1177\/03000605211012596","article-title":"Outcomes of late Kasai portoenterostomy in biliary atresia: a single-center experience","volume":"49","author":"Khayat","year":"2021","journal-title":"J Int Med Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1186\/s12887-018-1074-2","article-title":"Number of cholangitis episodes as a prognostic marker to predict timing of liver transplantation in biliary atresia patients after Kasai portoenterostomy","volume":"18","author":"Chen","year":"2018","journal-title":"BMC Pediatr"},{"key":"B11","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1097\/MPG.0000000000002555","article-title":"The epidemiology and etiology of cholangitis after Kasai portoenterostomy in patients with biliary atresia","volume":"70","author":"Baek","year":"2020","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B12","doi-asserted-by":"publisher","first-page":"366","DOI":"10.5223\/pghn.2021.24.4.366","article-title":"Analysis of cholangitis rates with extended perioperative antibiotics and adjuvant corticosteroids in biliary atresia","volume":"24","author":"Goh","year":"2021","journal-title":"Pediatr Gastroenterol Hepatol Nutr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e198","DOI":"10.3346\/jkms.2018.33.e198","article-title":"The prognostic value of CD8+ and CD45RO+ T cells infiltration and Beclin1 expression levels for early postoperative cholangitis of biliary atresia patients after Kasai operation","volume":"33","author":"Jiang","year":"2018","journal-title":"J Korean Med Sci"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1016\/j.jpedsurg.2021.03.039","article-title":"Biliary atresia liver histopathological determinants of early post-Kasai outcome","volume":"56","author":"Nguyen","year":"2021","journal-title":"J Pediatr Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"3945","DOI":"10.1007\/s00431-022-04612-7","article-title":"Diagnostic values of plasma matrix metalloproteinase-7, interleukin-8, and gamma-glutamyl transferase in biliary atresia","volume":"181","author":"Wu","year":"2022","journal-title":"Eur J Pediatr"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1007\/s00383-022-05230-y","article-title":"Adding a spur valve to laparoscopic portoenterostomy for patients with biliary atresia can achieve a high jaundice clearance rate and lower the number of episodes of cholangitis","volume":"38","author":"Yasui","year":"2022","journal-title":"Pediatr Surg Int"},{"key":"B17","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1016\/j.jpedsurg.2022.03.013","article-title":"Systematic review: the quality of life of patients with biliary atresia","volume":"57","author":"Le","year":"2022","journal-title":"J Pediatr Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1111\/jpc.13371","article-title":"Clinical significance of liver histology on outcomes in biliary atresia","volume":"53","author":"Webb","year":"2017","journal-title":"J Paediatr Child Health"},{"key":"B19","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1016\/j.jpedsurg.2017.10.001","article-title":"Correlation between gamma-glutamyl transpeptidase activity and outcomes after Kasai portoenterostomy for biliary atresia","volume":"53","author":"Ihn","year":"2018","journal-title":"J Pediatr Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e181161","DOI":"10.1001\/jamapediatrics.2018.1161","article-title":"Association of exposure to formula in the hospital and subsequent infant feeding practices with gut microbiota and risk of overweight in the first year of life","volume":"172","author":"Forbes","year":"2018","journal-title":"JAMA Pediatr"},{"key":"B21","doi-asserted-by":"publisher","first-page":"20201810","DOI":"10.1098\/rspb.2020.1810","article-title":"Modelling the effect of birth and feeding modes on the development of human gut microbiota","volume":"288","author":"Xiong","year":"2021","journal-title":"Proc R Soc B"},{"key":"B22","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1007\/s00383-018-4240-6","article-title":"Intravenous immunoglobulin for the treatment of intractable cholangitis after Kasai portoenterostomy in biliary atresia patients","volume":"34","author":"Li","year":"2018","journal-title":"Pediatr Surg Int"},{"key":"B23","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1002\/hep.32800","article-title":"Serum bile acids as a prognostic biomarker in biliary atresia following Kasai portoenterostomy","volume":"77","author":"Harpavat","year":"2023","journal-title":"Hepatology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"101764","DOI":"10.1016\/j.bpg.2021.101764","article-title":"Long-term outcomes of biliary atresia patients surviving with their native livers","author":"Hukkinen","year":"2022","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"185","DOI":"10.4103\/jiaps.JIAPS_96_18","article-title":"Early cholangitis after portoenterostomy in children with biliary atresia","volume":"24","author":"Ramachandran","year":"2019","journal-title":"J Indian Assoc Pediatr Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1055\/s-0039-1692686","article-title":"Perioperative complications after Kasai hepatoportoenterostomy: data from the Swiss National Biliary Atresia Registry","volume":"30","author":"Calinescu","year":"2020","journal-title":"Eur J Pediatr Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1939","DOI":"10.1007\/s00383-022-05258-0","article-title":"Relationship between the expression levels of CD4+ T cells, IL-6, IL-8 and IL-33 in the liver of biliary atresia and postoperative cholangitis, operative age and early jaundice clearance","volume":"38","author":"Zhang","year":"2022","journal-title":"Pediatr Surg Int"},{"key":"B28","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1016\/j.surg.2018.10.032","article-title":"Very low bilirubin after portoenterostomy improves survival of the native liver in patients with biliary atresia by deferring liver fibrogenesis","volume":"165","author":"Hukkinen","year":"2019","journal-title":"Surgery"},{"key":"B29","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1002\/lt.24640","article-title":"Biliary atresia: indications and timing of liver transplantation and optimization of pretransplant care","volume":"23","author":"Sundaram","year":"2017","journal-title":"Liver Transpl"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1189792\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T21:19:14Z","timestamp":1689196754000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1189792\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,12]]},"references-count":29,"alternative-id":["10.3389\/fped.2023.1189792"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.1189792","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,12]]},"article-number":"1189792"}}