The charts of all BA patients living in France and born between 1986 and 2009 were reviewed. Patients were divided into 3 cohorts according to their years of birth: 1986-1996, 1997-2002, and 2003-2009.
1107 BA children were identified, 990 born in metropolitan France (incidence 1/18,400 live births). Kasai operation was performed in 1044 (94 % ), leading to complete clearance of jaundice (total serum bilirubin ?20 ¦Ìmol/L) in 38 % of patients. Survival with native liver (SNL) after Kasai operation was 40 % , 36 % , and 30 % at 5, 10, and 20 years, stable in the 3 cohorts. Median age at Kasai operation was 59 days, unchanged over time. Twenty-year SNL was 39 % , 32 % , 28 % , and 19 % after Kasai operation performed in the first, second, third months of life or thereafter (p = 0.0002). 588 children underwent 692 LTs. Mortality without transplantation decreased over time: 16 % , 7 % , and 4 % in the 3 cohorts (p <0.0001). Survival after transplantation was 83 % , 82 % , and 77 % at 5, 10, and 20 years in the whole series. Five-year post-transplant survival was 75 % , 90 % , and 89 % in the 3 cohorts (p <0.0001). In the whole series, overall BA patient survival was 81 % , 80 % , and 77 % at 5, 10, and 20 years. Five-year BA patient overall survival increased over time: 72 % , 88 % , and 89 % in the 3 cohorts (p <0.0001).
BA patients currently have an 89 % live expectancy, and a 30 % chance to reach adulthood without transplantation. Early Kasai operation, without age threshold, reduces the need for liver transplantation until adulthood.