Prognostic Outcomes by Ishak Fibrosis Score Grouping in Biliary Atresia After Kasai Surgery

Objective: This study aimed to assess the native liver survival (NLS) of biliary atresia (BA) patients with varying Ishak scores post Kasai portoenterostomy (KPE). Methods: A prospective cohort study analyzed 83 BA patients who underwent KPE. Patients were stratified into Mild Fibrosis Group (Ishak 1– 2, n=20), Moderate Fibrosis Group (Ishak 3– 4, n=39), and Cirrhosis Group (Ishak 5– 6, n=24) based on postoperative Ishak scores. At the 6-month postoperative follow-up, clinical characteristics and liver function test outcomes were compared between groups to evaluate postoperative recovery profiles. Results: Generalized estimating equations (GEE) revealed time-dependent declines in ALT, AST, ALP, and Total Bile Acid (TBA) across groups ( P < 0.05), with cirrhosis patients exhibiting higher GGT and bilirubin levels vs. mild fibrosis ( P < 0.05). 6-month Clearance of Jaundice (CoJ) differed significantly: 55.0% (mild) vs. 38.5% (moderate) vs. 8.3% (cirrhosis) (P=0.003). Six-month NLS sharply declined with fibrosis severity: 80.0% (mild) vs. 16.7% (cirrhosis) ( P < 0.001). Multivariate logistic regression identified lower Ishak scores and younger surgical age as independent predictors of survival ( P < 0.05). Conclusion: KPE improved liver function, but the Cirrhosis Group had poorer outcomes. Hepatic fibrosis severity correlated negatively with NLS, highlighting the importance of early surgery. Keywords: biliary atresia, Kasai portoenterostomy, liver fibrosis, Ishak score, prognostic