Faktor Prediktor Native Liver Survival Satu Tahun Pascaprosedur Kasai pada Anak Dengan Atresia Bilier

REKNO WIDATI, Dr. dr. Titis Widowati, Sp. A(K); dr. Wahyu Damayanti, M.Sc., Sp. A(K); Dr. Nenny Sri Mulyani, Sp. A(K),

2026 | Tesis-Subspesialis | SUBSPESIALIS ILMU KESEHATAN ANAK

Latar Belakang: Meskipun prosedur Kasai berhasil dilakukan, pasien tetap dapat mengalami penyakit hati kronik sehingga diperlukan transplantasi hati. Kadar serum albumin dan skor Aspartate Aminotransferase to Platelet Ratio Index (APRi) pra-prosedur Kasai, serta penurunan bilirubin total pada 7 hari pasca-prosedur Kasai dapat digunakan sebagai prediktor native liver survival (NLS).

Tujuan: Menganalisis pengaruh kadar albumin dan skor APRi pra-prosedur Kasai, serta penurunan bilirubin 7 hari pasca-prosedur Kasai terhadap NLS 1 tahun pada pasien atresia bilier.

Metode: Studi kohort retrospektif dilakukan pada pasien atresia bilier usia 0-5 tahun di Rumah Sakit Sardjito Yogyakarta, Indonesia, Januari 2020 hingga Desember 2023. Data klinis, laboratoris serta operatif pra- dan pasca-prosedur Kasai dikumpulkan. Dilakukan penghitungan kadar albumin dan skor APRi praprosedur Kasai, penurunan bilirubin 7 hari pasca-prosedur Kasai, serta NLS. Prediktor independen diamati menggunakan regresi logistik bivariat dan multivariat. Native liver survival 1 tahun pasca-prosedur Kasai dianalisis dengan hazard ratio dan kurva Kaplan Meier.

Hasil: Sebanyak 34 subjek penelitian, 19 (55,8%) perempuan, 47,05% mengalami NLS, dengan usia rata-rata saat dilakukan prosedur Kasai pada kelompok NLS 82.56 ± 23.98 hari. Native liver survival pasien atresia bilier 1 tahun pasca-prosedur Kasai 47,1%. Kadar albumin serum pra-prosedur Kasai dan penurunan bilirubin total 7 hari pasca-prosedur Kasai merupakan variabel yang signifikan memengaruhi NLS, dengan AHR 3,21 (CI 95% 1,23-8,36, P=0,017) dan 6,14 (CI 95% 1,72-21,90, P=0,005).

Kesimpulan: Kadar albumin pra-prosedur Kasai, dan penurunan bilirubin 7 hari pasca-prosedur Kasai merupakan variable yang signifikan mempengaruhi NLS 1 tahun pasca-prosedur Kasai.

Background: Despite successful Kasai procedure, patients may develop chronic liver disease, thereby necessitating liver transplantation. Pre-Kasai serum albumin levels and APRi scores, along with total bilirubin reduction 7 days post-Kasai have been proposed as predictors of NLS.

Objective: Analyze the effects of pre-Kasai serum albumin levels and APRi scores, along with total bilirubin reduction 7 days post-Kasai, on 1-year NLS in biliary atresia patients.

Methods: A retrospective cohort study was conducted among biliary atresia patients aged 0–5 years at Sardjito Hospital, Yogyakarta, Indonesia, from January 2020-December 2023. Clinical, laboratory, and operative data before and after Kasai procedure were collected. Pre-Kasai serum albumin levels and APRi scores, total bilirubin reduction 7 days post-Kasai, and NLS were calculated. Independent predictors of 1-year NLS were identified using bivariate and multivariate logistic regression analyses. One-year NLS was further evaluated using hazard ratios and Kaplan–Meier curves.

Result: A total of 34 patients were included, 19 (55.8%) of whom were female, and NLS was observed in 47.05% of patients, with a mean age at Kasai of 82.56 ± 23.98 days. The one-year NLS rate after Kasai procedure was 47.1%. Pre-Kasai serum albumin levels and total bilirubin reduction 7 days post-Kasai were significantly associated with NLS (AHR 3.21, 95% CI 1.23–8.36, p = 0.017 and AHR 6.14, 95% CI 1.72–21.90, p = 0.005).

Conclusion: Pre-Kasai serum albumin levels and the reduction in total bilirubin 7 days post-Kasai procedure were associated with 1-year NLS.

Kata Kunci : predictor factors, native liver survival, post-Kasai procedure, biliary atresia