Hubungan Antara Rasio Duktus Biliaris/Traktus Portal Dengan Kesintasan Pasien Atresia Bilier Pasca Operasi Kasai di RSUP Sardjito

MAURA ANDINI S, dr. Gunadi, Ph.D., SpBA., Subsp.DA.(K); dr. Hanggoro Tri Rinonce, Ph.D., Sp.PA.(K)

2023 | Skripsi | S1 KEDOKTERAN

Latar Belakang. Di Indonesia, operasi Kasai menjadi tata laksana utama penyakit atresia bilier (AB) dikarenakan prosedur transplantasi hati masih sangat terbatas. Namun, terdapat beberapa komplikasi yang dapat menyertai prosedur ini. Temuan histopatologi, seperti proliferasi sel epitel duktus biliaris dinilai mampu memprediksi prognosis pasien pasca Kasai. Ada tidaknya proliferasi dapat digambarkan oleh rasio duktus biliaris/traktus portal (DB/TP) melalui pewarnaan IHK CK7. Tujuan. Untuk mengetahui hubungan antara jenis kelamin, usia saat operasi Kasai, tipe AB, hasil laboratorium praoperatif, serta rasio DB/TP terhadap kesintasan pasien AB pasca operasi Kasai. Metode. Penelitian ini merupakan penelitian kohort retrospektif yang dilakukan pada pasien AB yang telah melalui operasi Kasai di RSUP Dr. Sardjito pada tahun 2017 hingga 2021. Data yang digunakan berupa data primer hasil pembacaan ulang rasio DB/TP dan data sekunder yang diperoleh dari rekam medis. Analisis dilakukan dengan menggunakan Fisher's Exact Test, kurva Kaplan-Meier, Log-Rank Test, dan uji multivariat dengan Regression Logistic dan Regression Cox. Hasil. Terdapat 21 subjek yang terlibat dalam penelitian ini, dimana 14 adalah perempuan dan 7 adalah laki-laki. Median usia saat operasi Kasai adalah 92 hari (interquartile range (IQR) 84,5-101 hari). Didapatkan 15 subjek (71,4%) memiliki luaran hidup. Berdasarkan variabel karakteristik dasar, kadar ALT menjadi satu-satunya variabel yang dinilai berkaitan secara signifikan secara statistik dengan kesintasan, baik dengan (p= 0,005) atau tanpa (p= 0,031) memperhatikan unsur waktu, setelah mempertimbangkan hubungan dengan variabel lain. Rasio DB/TP dinilai tidak berkaitan secara signifikan dengan kesintasan, baik dengan (p= 0,126) atau tanpa (p= 0,178) memperhatikan unsur waktu, tetapi ditemukan adanya kecenderungan kelompok subjek dengan rasio DB/TP >= 1,085 berkaitan dengan risiko yang lebih tinggi mengalami kematian (hazard ratio (HR)= 3,9). Kesimpulan. Rasio DB/TP dinilai tidak memiliki hubungan yang signifikan dengan kesintasan. Terdapat hubungan yang signifikan antara ALT dengan kesintasan, variabel selain itu tidak dinilai memiliki hubungan yang signifikan.

Background. In Indonesia, Kasai surgery is the main treatment for biliary atresia (BA) because liver transplant are still very limited. However, there are some complications that can follow this procedure. Histopathological findings, such as the proliferation of bile duct epithelial cells, are considered to be able to predict the prognosis of post-Kasai patients. The presence or absence of proliferation can be described by the ratio of biliary duct/portal tract (BD/PT) through CK7 staining. Objective. To determine the relationship between gender, age at Kasai surgery, type AB, preoperative laboratory results, and the DB/TP ratio on the survival of BA patients after Kasai surgery. Method. This study was a retrospective cohort study conducted on BA patients who had undergone Kasai surgery at Dr. Sardjito in 2017 to 2021. The data used is in the form of primary data from rereading the DB/TP ratio and secondary data obtained from medical records. Analysis was performed using Fisher's Exact Test, Kaplan-Meier curve, Log-Rank Test, and multivariate test using Regression Logistic and Regression Cox. Result. There were 21 subjects involved in this study, of which 14 were women and 7 were men. The median age at Kasai surgery was 92 days (interquartile range (IQR) 84,5-101 days). It was found that 15 subjects (71,4%) had a life outcome. Based on the basic characteristic variables, ALT levels were the only variable that was considered to be statistically significantly related to survival, either with (p= 0,005) or without (p= 0,031) taking into account the element of time, after considering the relationship with other variables. The DB/TP ratio was considered not significantly related to survival, either with (p= 0,126) or without (p= 0,178) taking into account the time element, but a tendency was found for the group of subjects with a BD/PT ratio >= 1,085 associated with a higher risk of experiencing death (hazard ratio (HR) = 3,9). Conclusion. The DB/TP ratio is considered to have no significant relationship with survival. There is a significant relationship between ALT and survival, the other variables are not considered to have a significant relationship.

Kata Kunci : Atresia bilier, prosedur Kasai, CK7, rasio DB/TP, kesintasan