The aim is to explore the impact of the Kasai procedure (KP) and the length of native liver survival time (NLST) on outcomes of liver transplantation (LT). Patients with biliary atresia (BA), who underwent LT in Beijing Friendship Hospital from January 2017 to December 2019, were enrolled and divided into non-KP (N-KP) and post-KP (P-KP) groups. The patients in the P-KP group were further divided into early failure (KP-EF) defined by NLST <1 year, medium failure (KP-MF, NLST 1-5 years), and late failure (KP-LF, NLST >5 years) subgroups. Clinical data at baseline and during follow-up were collected. The inverse probability of treatment weighting method was used to evaluate the independent effect of KP and the length of NLST on clinical outcomes. Among 197 patients with BA, the N-KP group accounted for 43 (21.8%), KP-EF 71 (46.1%), KP-MF 59 (38.3%), and KP-LF 24 (15.6%) cases, respectively. The N-KP and KP-EF groups had significantly longer hospitalization and intensive care unit stays after LT. Graft and overall survival rates were 93.0% in the N-KP group and 97.4% in P-KP group, respectively. The mortality rate in the P-KP group were significantly lower compared with that of the N-KP group with a hazard ratio (HR) of 0.2 (P = 0.02). The risks of biliary and vascular complications and cytomegalovirus (CMV) infection after LT were significantly higher in KP-EF group than those in the KP-MF and KP-LF groups (HRs = 0.09, 0.2, and 0.3, respectively; all P < 0.001). The KP significantly improved after LT overall survival. Patients with early native liver failure after KP have significantly higher risks for biliary and vascular complications and CMV infection.

中文翻译：

---

Kasai 手术和原肝存活时间长短对胆道闭锁肝移植结果的影响

目的是探讨 Kasai 手术 (KP) 和天然肝脏存活时间 (NLST) 的长度对肝移植 (LT) 结果的影响。纳入2017年1月至2019年12月在北京友谊医院接受肝移植的胆道闭锁（BA）患者，分为非KP（N-KP）组和KP后（P-KP）组。P-KP组患者进一步分为早期失败（KP-EF）定义为NLST<1年、中度失败（KP-MF、NLST 1-5年）和晚期失败（KP-LF、NLST> 5 年）亚组。收集了基线和随访期间的临床数据。治疗加权方法的逆概率用于评估KP和NLST长度对临床结果的独立影响。197例BA患者中，N-KP组43例（21.8%），KP-EF组71例（46.1%），KP-MF 59 (38.3%) 例和 KP-LF 24 (15.6%) 例。N-KP 和 KP-EF 组在 LT 后住院和重症监护病房的时间明显更长。N-KP 组的移植物存活率和总存活率分别为 93.0% 和 P-KP 组的 97.4%。P-KP组的死亡率明显低于N-KP组，风险比（HR）为0.2（P  = 0.02）。KP-EF 组 LT 后胆道和血管并发症以及巨细胞病毒 (CMV) 感染的风险显着高于 KP-MF 和 KP-LF 组（HR 分别 = 0.09、0.2 和 0.3；所有P  < 0.001）。LT 总生存期后 KP 显着改善。KP 后早期天然肝功能衰竭的患者发生胆道和血管并发症以及 CMV 感染的风险明显更高。