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Purpose <p>We compared the long-term outcomes of open (OKPE) versus laparoscopic Kasai portoenterostomy (LKPE) for children with biliary atresia (BA) who ultimately progressed to liver transplantation (LT).</p> Methods <p>The subjects of this retrospective multicenter analysis were 276 BA patients (OKPE:225, LKPE:51) undergoing living donor liver transplantation (LDLT) between 2021 and 2023. Propensity score matching (PSM, 51 pairs) and inverse probability treatment weighting (IPTW) balanced the confounders. The time from KPE to LDLT was assessed using Kaplan-Meier curves and Cox regression analysis.</p> Results <p>There were no significant differences in the median time from KPE to LDLT between the OKPE and LKPE groups (228 days vs. 203 days, <i>p</i> = 0.756). Multivariable Cox regression identified patient age at KPE (HR = 1.002, <i>p</i> &lt; 0.01), but not the surgical approach, as a factor influencing the timing of transplantation. No significant differences were observed in postoperative complications, LDLT-free survival rates, or intraoperative transplant metrics between the groups.</p> Conclusions <p>For BA infants who progress to LT after KPE, OKPE and LKPE have comparable impact on post-KPE complications, survival time, and outcomes following LT. Thus, the emphasis should be on optimal surgical timing and standardized postoperative management.</p>

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Comparative outcomes of open and laparoscopic Kasai portoenterostomy for biliary Atresia patients progressing to liver transplantation: A Real-World cohort study

  • 期刊论文

  • 发表日期：

    2025年12月12日

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  • Yanran Zhang,
  • Yaqiong Qiu,
  • Shuai Wang,
  • Jiaying Liu,
  • Xingyuan Ke,
  • Shaowen liu,
  • Rongjuan Sun,
  • Yilin Zhao,
  • Xin Li,
  • Shengqiao Zhao,
  • Zhixin Zhang,
  • Xinzhe Wei,
  • Wei Gao,
  • Jianghua Zhan

摘要

Purpose

We compared the long-term outcomes of open (OKPE) versus laparoscopic Kasai portoenterostomy (LKPE) for children with biliary atresia (BA) who ultimately progressed to liver transplantation (LT).

Methods

The subjects of this retrospective multicenter analysis were 276 BA patients (OKPE:225, LKPE:51) undergoing living donor liver transplantation (LDLT) between 2021 and 2023. Propensity score matching (PSM, 51 pairs) and inverse probability treatment weighting (IPTW) balanced the confounders. The time from KPE to LDLT was assessed using Kaplan-Meier curves and Cox regression analysis.

Results

There were no significant differences in the median time from KPE to LDLT between the OKPE and LKPE groups (228 days vs. 203 days, p = 0.756). Multivariable Cox regression identified patient age at KPE (HR = 1.002, p < 0.01), but not the surgical approach, as a factor influencing the timing of transplantation. No significant differences were observed in postoperative complications, LDLT-free survival rates, or intraoperative transplant metrics between the groups.

Conclusions

For BA infants who progress to LT after KPE, OKPE and LKPE have comparable impact on post-KPE complications, survival time, and outcomes following LT. Thus, the emphasis should be on optimal surgical timing and standardized postoperative management.