Objectives To evaluate incidence and timing of cholangitis and spontaneous bacterial peritonitis (SBP) in Biliary Atresia (BA), after Kasai Porto-enterostomy (KP), prior to liver transplantation (LT).
Methods A single-centre retrospective analysis, comprising 78 patients (36M:42F) who underwent KP between 2008–2010.
Results Cholangitis followed in 38/78 (48%) patients; median number of episodes 2 (range: 1, 5). Median age for first episode was 5.6 months (2, 72.5). Six patients showed dilated biliary radicles on ultrasound. Organisms were isolated from blood cultures in six patients; E-coli (n = 2), Staphylococcus Aureus, Klebsiella, Streptococcus Pneumonia and Pseudomonas. 27/38 (71%) cholangitic patients underwent LT, 10 are alive with their native liver and one died. Ascites developed in 29/78 (37%) patients, at median age 6.5 months (3.1, 66). Ascitic taps were performed in 41% (12/29), due to respiratory distress with fever (5/12) or without fever (7/12) at median age 7.4 months (3.2, 22.8). 16/17 patients that did not have ascitic taps underwent LT at a median age 17.2 months (7.4, 79.7) and one died whilst listed for LT. Timing of tap was at the onset of ascites in six patients and at a median time of 2 months (0.1, 4.6) from onset of ascites in the remaining six patients. Four patients fulfilled criteria for SBP diagnosis; 3 culture-negative (wcc >250 mm3), one bacteri-ascites (wcc <250 mm3; gram-positive cocci, gram-negative rods). No culture-positive SBP was identified. One culture-negative SBP revealed Streptococcus Pneumoniae in blood cultures. Five patients that underwent ascitic taps previously had cholangitis. Antibiotics were already commenced in 8/12 patients pre-tap. Raised plasma wcc (>17 mm3) was identified in SBP (3/4) and non-SBP (3/8) patients. All SBP patients underwent LT at a median age 10.5 months (7.1, 16.1). Non-SBP patients underwent LT (n = 4), are alive with native liver (n = 1) or died (n = 3; all listed for LT).
Conclusion Cholangitis and SBP occurred in 48% and 5% of BA patients respectively; cholangitis episodes presented earlier. Few cases revealed positive bacterial cultures. Definition of paediatric SBP needs to account for pre-culture antibiotic use. New molecular techniques should be sought to aid diagnosis. LT is a successful outcome for cholangitis, SBP and non-SBP ascites.
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