Kasai portoenterostomy: Differences related to race

Purpose: The aim of this study was to evaluate the Kasai portoenterostomy i n African-American and white children with respect to differences in presen tation and outcome. Methods: A retrospective review of all children with biliary atresia who un derwent a portoenterostomy at our institution over the last 15 years (n = 6 3) was performed. Sex, age at the time of Kasai, preoperative laboratory te sts, success rates (defined as postoperative total serum bilirubin less tha n or equal to 2.0 mg/dL), and survival rate were recorded. Differences betw een African-American (AA; n = 30) and white (W; n = 33) children were analy zed. Long-term follow-up was available on 59 of 63 patients. Results: Sixty-three percent of ail patients (40 of 65) were girls, and 48% were AA (30 of 63). A higher percentage of AA children (73%) were girls th an were white children (55%), although this difference did not achieve stat istical significance. African-Americans underwent portoenterostomy at a lat er age, had higher alkaline phosphatase levels, and higher AST. These diffe rences were statistically significant. Preoperative ALT, total bilirubin le vel, and GGTP levels all were greater in African-Americans, although these differences did not achieve statistical significance. There was a trend tow ard decreased success and survival rate, although these results also were n ot statistically significant. Conclusions: African-Americans underwent primary therapeutic intervention f or biliary atresia at an older age than white children with a trend toward less favorable results. These differences related to race may be attributed to greater difficulty in diagnosing jaundice or poorer access to health ca re in this patient population. Increased effort at identifying biliary atre sia in AA children may lead to earlier diagnosis and treatment and improved outcomes. J Pediatr Surg 36:1196-1198. Copyright (C) 2001 by W.B. Saunders Company.