Objective To compare the efficacy of two regimens of biliary atresia treated with Kasai-liver transplantation (LT) sequential therapy and direct primary LT. Methods A retrospective study was conducted on pediatric patients diagnosed with biliary atresia who underwent LT and met the inclusion and exclusion criteria at the Department of Pediatric Surgery, West China Hospital, Sichuan University, from January 2018 to January 2025. The enrolled children were divided into two groups according to treatment regimens: the Kasai-LT group and the direct primary LT group. Demographic data, general clinical data, intraoperative conditions, postoperative recovery, complications, and survival rates were compared between the two groups. Results A total of 300 pediatric patients were enrolled, including 225 in the Kasai-LT group and 75 in the primary LT group. After propensity score matching, there were 150 patients in the Kasai-LT group and 75 in the primary LT group. In terms of surgical parameters, the Kasai-LT group had a shorter operative time (P=0.005), stay in the pediatric intensive care unit (P=0.026), and total hospital stay (P=0.015), as well as lower hospitalization costs (P=0.017). No significant differences were observed in liver function recovery on postoperative day 7 between the two groups (P>0.05). The Kasai-LT group presented lower incidences of hepatic artery complications and thoracic and abdominal infections compared with the primary LT group (P=0.023 and P=0.003, respectively). The 5-year cumulative survival rates were 94.40% for the Kasai-LT group and 88.10% for the primary LT group, while the 5-year cumulative graft survival rates were 89.30% and 86.80%, respectively. No statistically significant differences were found between the two groups for either indicator (P>0.05). Conclusions Kasai procedure for biliary atresia can effectively improve LT conditions and reduce the rate of postoperative complications. For the treatment of biliary atresia, sequential Kasai procedure combined with LT is a viable option, and individualized therapeutic regimens should also be adopted.
Citation：
LUO Chengkun, XIE Zhenyu, JIN Shuguang, XIANG Bo, PENG Yun, CHEN Yang, SONG Jiulin. Sequential management strategy of liver transplantation in children with biliary atresia and its clinical value. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(6): 813-818. doi: 10.7507/1007-9424.202511110
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Copyright ? the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
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