{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:59:29Z","timestamp":1787169569218,"version":"build-2736575974"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Outcomes in biliary atresia (BA) have been well-documented in large national cohorts from Europe, North America, and East Asia. Understanding the challenges that preclude success of the Kasai portoenterostomy (KPE) is the key to improve the overall outcomes of BA and implementing intervention strategies. Here, we analyzed the data from the Saudi national BA study (204 BA cases diagnosed between 2000 and 2018) to identify the prognostic factors of BA outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>One hundred and forty-three cases underwent KPE. Several prognostic factors (center case load, congenital anomalies, serum gamma-glutamyl transferase, use of steroids, ascending cholangitis post-operatively, and degree of portal fibrosis at time of KPE) were investigated and correlated with the primary outcomes of interest: 1) success of KPE (clearance of jaundice and total serum bilirubin &lt;20 mmol\/l after KPE), 2) survival with native liver (SNL), and 3) overall survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Use of steroids after KPE was associated with clearance of jaundice, 68% vs. 36.8% in the BA cases that did not receive steroids (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.013; odds ratio 2.5) and a significantly better SNL rate at 2 - and 10-year of 62.22% and 57.77%\n                      <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                      . 39.47% and 31.57%, respectively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.01). A better 10-year SNL was observed in centers with caseload &lt;1\/year (group 1) as compared to centers that performed \u22651\/year (group 2) [45.34%\n                      <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                      . 26.66%, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.047]. On comparison of the 2 groups, cases in group 1 had KPE at significantly earlier age (median 59.5 vs. 75 days,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.006) and received steroids after KPE more frequently than group 2 (69% vs. 31%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). None of the remaining prognostic variables were identified as being significantly related to BA outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Steroids use post-KPE predicted clearance of jaundice and better short- and long-term SNL. There is a need to establish a national BA registry in Saudi Arabia aiming to standardize the pre- and post-operative clinical practices and facilitate clinical and basic research to evaluate factors that influence BA outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sjg.sjg_512_22","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T08:02:27Z","timestamp":1678953747000},"page":"286-294","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Predictors of biliary atresia outcome: Saudi National Study (2000 \u2013 2018)"],"prefix":"10.4103","volume":"29","author":[{"given":"Mohammed","family":"Abanemai","sequence":"first","affiliation":[{"name":"Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi 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