FAKTOR PROGNOSIS KESINTASAN 5 TAHUN PASIEN ATRESIA BILIER PASCA PROSEDUR KASAI DI RSUP DR. SARDJITO

DYAH UTAMI NUGRAHENI, dr. Gunadi, Ph.D., Sp.BA; Dr. dr. Akhmad Makhmudi, Sp.B, Sp.BA(K); dr. Ira Puspitawati, M.Kes., Sp.PK(K)

2019 | Skripsi | S1 KEDOKTERAN

Latar Belakang: Atresia bilier (AB) merupakan penyakit kongenital idiopatik berupa fibro-obliterasi progresif duktus bilier ekstra- dan intrahepatik sehingga bermanifestasi kekuningan (jaundice) > 2 minggu. Insidensi AB di Yogyakarta dilaporkan terjadi tiap 1:7000 kelahiran hidup. Tata laksana awal atresia bilier adalah operasi Kasai. Prosedur Kasai meningkatkan kesintasan pasien AB dengan native liver. Kesintasan pasien ditentukan oleh beberapa faktor, antara lain usia saat operasi, kadar bilirubin 7 hari pasca operasi, pengalaman operator, AST dan ALT pre operasi, AST dan ALT 7 hari pasca operasi, rasio AST7/AST0, serta rasio ALT7/ALT0. Penelitian spesifik mengenai faktor prognosis kesintasan pasien AB pasca Kasai di Indonesia masih terbatas, terutama untuk kesintasan 5 tahun. Tujuan: Untuk mengetahui faktor prognosis kesintasan 5 tahun pasien AB pasca prosedur Kasai di RSUP Dr. Sardjito. Metode: Penelitian ini merupakan penelitian kohort retrospektif yang menggunakan 24 data rekam medis pasien AB yang menjalani operasi Kasai di RSUP Dr. Sardjito. Analisis ROC untuk menentukan nilai cut-off parameter laboratorium, analisis univariat menggunakan uji Pearson Chi-square atau Fisher's exact, dan analisis kesintasan 5 tahun dengan uji Kaplan-Meier. Hasil: Tidak terdapat hubungan antara faktor usia saat operasi (p=0,408), TB7 (p=0,973), pengalaman operator (p=0,649), AST pre operasi (p=0,973), AST 7 hari pasca operasi (p=1), rasio AST7/AST0 (p=0,682), ALT pre operasi (p=0,682), ALT 7 hari pasca operasi (p=0,697), dan rasio ALT7/ALT0 (p=1) dengan kesintasan 5 tahun pasien AB pasca prosedur Kasai. Analisis kesintasan 5 tahun menggunakan uji Kaplan-Meier didapatkan hasil tidak signifikan, berupa usia saat operasi (p=0,264), TB7 (p=0,961), pengalaman operator (p=0,479), AST0 (p=0,993), AST7 (p=0,931), rasio AST7/AST0 (p=0,562), ALT0 (p=0,708), ALT7 (p=0,640), dan rasio ALT7/ALT0 (p=0,963). Kesimpulan: Usia saat operasi, bilirubin 7 hari pasca operasi, pengalaman operator, AST pre operasi, AST 7 hari pasca operasi, rasio AST7/AST0, ALT pre operasi, ALT 7 hari pasca operasi, dan rasio ALT7/ALT0 bukan merupakan faktor prognosis kesintasan 5 tahun pasien AB pasca prosedur Kasai.

Background: Biliary atresia (BA) is a congenital idiopathic disease characterized by progressive fibro-obliteration of extra-and intrahepatic biliary ducts that manifest jaundice > 2 weeks. The incidence of BA in Yogyakarta is reported to occur every 1: 7000 live births. The initial management of BA is Kasai procedure. The Kasai procedure can increase patient survival with native liver. Patient survival is determined by several factors, include age at surgery, operator experience, preoperative AST and ALT, 7-day postoperative bilirubin, AST and ALT, AST7/AST0 ratio, and ALT7/ALT0 ratio. Specific research regarding the prognostic factor of survival post-Kasai BA patients in Indonesia is still limited, especially for 5-years survival. Objective: To determine the prognostic factors for 5-years survival of BA patients after Kasai procedure at RSUP Dr. Sardjito Method: This study was a cohort retrospective design used 24 medical records BA patients undergoing Kasai procedure in RSUP Dr. Sardjito. The ROC analysis to determine the cut-off value of laboratory parameters. Pearson Chi-square or Fisher's exact test for univariate analysis and Kaplan-Meier test for 5-year survival analysis. Results: There was no correlation between age at surgery (p=0.408, O), 7-day post-operative bilirubin (p=0.973), operator experience (p=0.649), pre-operative AST (p=0.973), 7-day postoperative AST (p=1), AST7/AST0 ratio (p=0.682), pre-operative ALT (p=0.682), 7-day postoperative ALT (p=0.697), and ALT7/ALT0 ratio (p=1) to the 5-years survival BA patients after Kasai procedure. A 5-year survival analysis using the Kaplan-Meier test obtained no significant results, age at surgery (p=0.264), TB7 (p=0.961), operator experience (p=0.479), AST0 (p=0.993), AST7 (p=0.931) , AST7/AST0 ratio (p= 0.562), ALT0 (p=0.708), ALT7 (p=0.640), and ALT7/ALT0 ratio (p=0.963). Conclusion: Age at surgery, 7-day post-operative bilirubin, operator experience, pre-operative AST, 7-day postoperative AST, AST7/AST0 ratio, pre-operative ALT, 7-day postoperative ALT, and ALT7/ALT0 ratio were not prognostic factors of 5-years survival BA patients after the Kasai procedure

Kata Kunci : Kata kunci: atresia bilier, kesintasan 5 tahun, prosedur Kasai, faktor prognosis/ Keywords: biliary atresia, 5-years survival, Kasai procedure, prognostic factors