Improving poor outcomes of children with Biliary Atresia in South Africa by early referral to centralized units

dc.contributor.authorvan der Schyff, Francisca
dc.contributor.authorTerblanche, Alberta J.
dc.contributor.authorBotha, Jean F.
dc.date.accessioned2025-03-19T07:31:03Z
dc.date.issued2021
dc.departmentPaediatrics
dc.description.abstractObjectives: Biliary atresia (BA) is a progressive fibrosing cholangiopathy of infancy, the most common cause of cholestatic jaundice in infants and the top indication for liver transplantation in children. Kasai portoenterostomy (KPE) when successful may delay the requirement for liver transplantation, which in the majority offers the only cure. Good outcomes demand early surgical intervention, appropriate management of liver cirrhosis, and in most cases, liver transplantation. These parameters were audited of children with BA treated at the Steve Biko Academic Hospital (SBAH) in Pretoria, South Africa. Methods: All children with BA who were managed at SBAH between June 2007 and July 2018 were included. Parameters measured centered on patient demographics, timing of referral and surgical intervention, immediate and long-term outcomes of surgery, and follow-up management. Results: Of 104 children treated, 94 (90%) were KPE naive. Only 23/86 (26%) of children were referred before 60 days of life and 42/86 (49%) after 120 days. Median time to surgical assessment and surgery was 4 (IQR 1–70) and 5 (IQR 1–27) days post presentation, respectively. The median age at KPE was 91 days (IQR 28–165), with only 4/41 (12%) of KPEs performed before 60 days of life. Of those with recorded outcomes, 12/33 (36%) achieved resolution of jaundice. Only a third of the cohort were referred for transplantation. Conclusion: Children with BA have poor outcomes in the public health sector in South Africa. Late referrals, delayed diagnostics, advanced age at KPE with low drainage rates, poor follow–up, and low transplant rates account for low survival. Early referral to units offering expert intervention at all stages of care, including transplantation, would offer the best outcomes.
dc.description.submitterPM2025
dc.facultyFaculty of Health Sciences
dc.identifier.citationvan der Schyff, F., Terblanche, A. J., & Botha, J. F. (2021). Improving Poor Outcomes of Children With Biliary Atresia in South Africa by Early Referral to Centralized Units. JPGN reports, 2(2), e073. https://doi.org/10.1097/PG9.0000000000000073
dc.identifier.issn0277-2116 (print)
dc.identifier.issn1536-4801 (online)
dc.identifier.other10.1097/PG9.0000000000000073
dc.identifier.urihttps://hdl.handle.net/10539/44375
dc.journal.titleJournal of Pediatric Gastroenterology and Nutrition Reports
dc.language.isoen
dc.publisherWolters Kluwer.
dc.relation.ispartofseriesVol.2; No.2 (e073)
dc.rights© 2021 The Author(s). Published by Wolters Kluwer.
dc.schoolSchool of Clinical Medicine
dc.subjectLiving donor liver transplants
dc.subjectEnd-stage liver failure
dc.subjectLiver transplant
dc.subjectCholestatic jaundice
dc.subjectChildren with Biliary atresia
dc.subject.primarysdgSDG-3: Good health and well-being
dc.subject.secondarysdgSDG-16: Peace, justice and strong institutions
dc.titleImproving poor outcomes of children with Biliary Atresia in South Africa by early referral to centralized units
dc.typeArticle

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