Endoscopic retrograde cholangiopancreatography for diagnosing and treating pediatric biliary and pancreatic diseases

Relationship between hepatic function recovery and postoperative cholangitis in neonates undergoing hepaticojejunostomy for biliary atresia

OBJECTIVE

To explore the association between hepatic function recovery and the incidence of postoperative cholangitis in neonates with biliary atresia (BA) who underwent hepaticojejunostomy.

METHODS

We conducted a retrospective analysis of medical records from 173 newborns diagnosed with BA and treated with hepaticojejunostomy (Kasai procedure) between February 2020 and October 2022. Participants were categorized into two cohorts: those who developed cholangitis post-surgery (cholangitis group, n=125) and those who did not (non-cholangitis group, n=48). Liver function indices pre- and post-treatment, the extent of postoperative liver function recovery, and jaundice resolution rates were compared. Risk factors for cholangitis development post-surgery were identified using univariate and multifactorial logistic regression analyses.

RESULTS

The cholangitis group exhibited higher surgical weight (P=0.030) and elevated preoperative levels of total bilirubin (TB, P<0.001), direct bilirubin (DB, P<0.001), aspartate aminotransferase (AST, P<0.001), and gamma-glutamyl transferase (GGT, P<0.001). This group also showed better postoperative liver function recovery (P=0.002) and jaundice clearance rates (P=0.003). Logistic regression identified postoperative jaundice clearance (P=0.013), TB (P=0.004), DB (P=0.011), AST (P<0.001), and GGT (P<0.001) as independent risk factors for cholangitis. The nomogram model had a C-index of 0.930 with a goodness-of-fit test p-value of 0.873, and an AUC of 0.930.

CONCLUSION

Postoperative jaundice clearance, TB, DB, AST, and GGT are independent risk factors for cholangitis. The nomogram model offers high predictive accuracy for cholangitis development, aiding early intervention and prognosis improvement in high-risk neonates.