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Liver Failure and Liver Disease
Article first published online: 23 JUN 2006
Copyright © 2006 American Association for the Study of Liver Diseases
Volume 44, Issue 1, pages 75–84, July 2006
How to Cite
Serinet, M.-O., Broué, P., Jacquemin, E., Lachaux, A., Sarles, J., Gottrand, F., Gauthier, F. and Chardot, C. (2006), Management of patients with biliary atresia in France: Results of a decentralized policy 1986-2002. Hepatology, 44: 75–84. doi: 10.1002/hep.21219
The collaboration of pediatricians and surgeons of 45 participating centers is listed in the Acknowledgment section.
Preliminary results were presented at the 62nd Congress of the French Society of Paediatric Surgery, Reims, September 2005; and at the 27th Congress of the French speaking group of pediatric hepatology gastroenterology and nutrition, Fez (Morocco), April 2006.
Potential conflict of interest: Nothing to report.
- Issue published online: 23 JUN 2006
- Article first published online: 23 JUN 2006
- Manuscript Accepted: 3 APR 2006
- Manuscript Received: 13 JAN 2006
- Programme Hospitalier de Recherche Clinique national 2002. Grant Number: AOM 02 007
This study analyzed the results of the decentralized management of biliary atresia (BA) in France, where an improved collaboration between centers has been promoted since 1997. Results were compared to those obtained in England and Wales, where BA patients have been centralized in three designated centers since 1999. According to their birth dates, BA patients were divided into two cohorts: cohort A, with patients born between 1986 and 1996, had 472 patients; and cohort B, with patients born between 1997 and 2002, had 271 patients. Survival rates were calculated according to the Kaplan-Meier method and compared by using the log rank test and the Cox model. Four-year overall BA patient survival was 73.6% (95% CI 69.5%-77.7%) and 87.1% (CI 82.6%-91.6%) in cohorts A and B, respectively (P < .001). Median age at time of the Kasai operation was 61 and 57 days in cohorts A and B, respectively (NS). Four-year survival with native liver after the Kasai operation was 40.1% and 42.7% in cohorts A and B, respectively (NS): 33.9% (cohort A) and 33.4% (cohort B) in the centers with two or fewer caseloads a year, 30.9% (cohort A) and 44.5% (cohort B) in the centers with 3-5 cases/year, 47.8% (cohort A) and 47.7% (cohort B) in the center with more than 20 caseloads a year. In cohorts A and B, 74 (15.7%) and 19 (7%) patients, respectively, died without liver transplantation (LT). Four-year survival after LT was 75.1% and 88.8% in cohorts A and B, respectively (P = .006). In conclusion, BA patients currently have the same chance of survival in France as in England and Wales. The early success rate of the Kasai operation remains inferior in the centers with limited caseloads in France, leading to a greater need for LTs in infancy and early childhood. (HEPATOLOGY 2006;44:75–84.)