Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2015; 21(46): 13080-13086
Published online Dec 14, 2015. doi: 10.3748/wjg.v21.i46.13080
Reduction of the ages at diagnosis and operation of biliary atresia in Taiwan: A 15-year population-based cohort study
Jen-Shyang Lin, Solomon Chih-Cheng Chen, Chin-Li Lu, Hung-Chang Lee, Chun-Yan Yeung, Wai-Tao Chan
Jen-Shyang Lin, Solomon Chih-Cheng Chen, Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan
Jen-Shyang Lin, Chun-Yan Yeung, Wai-Tao Chan, Hung-Chang Le, Department of Pediatric Gastroenterology, MacKay Children’s Hospital, Taipei 10449, Taiwan
Solomon Chih-Cheng Chen, Department of Pediatrics, School of Medicine, Taipei Medical University, Taipei 11031, Taiwan
Chin-Li Lu, Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
Author contributions: Chen SCC and Lee HC conceptualized and designed the research; Chen SCC and Lu CL analyzed data; Lin JS, Chen SCC and Lu CL drafted the paper; All authors critically reviewed the paper and approved the final manuscript.
Supported by The Ditmanson Medical Foundation Chia-Yi Christian Hospital Research Program, No. R102-11.
Institutional review board statement: The Institutional Review Board of Ditmanson Medical Foundation Chia-Yi Christian Hospital has approved this study (CYCH-IRB No. 102023).
Informed consent statement: No written informed consent is obtained since all the data have been de-identified before analysis.
Conflict-of-interest statement: Non-declared.
Data sharing statement: Dataset is available from the corresponding author at solomon.ccc@gmail.com. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Solomon Chih-Cheng Chen, MD, MSc, PhD, Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East District, Chiayi 60002, Taiwan. solomon.ccc@gmail.com
Telephone: +886-5-2765041-5573 Fax: +886-5-2767489
Received: July 19, 2015
Peer-review started: July 20, 2015
First decision: August 26, 2015
Revised: September 7, 2015
Accepted: November 9, 2015
Article in press: November 9, 2015
Published online: December 14, 2015
Abstract

AIM: To describe the ages at diagnosis and operation of biliary atresia (BA) and its incidence over a 15-year period in Taiwan.

METHODS: This was a population-based cohort study. BA cases were identified from the Taiwan National Health Insurance Research Database based on the International Classification of Diseases, Ninth Revision (ICD-9) code of BA 751.61 plus Kasai operation (ICD-9 procedure code 51.37) or liver transplantation (LT, ICD-9 procedure code 50.5). The patients’ characteristics including sex, age at diagnosis, age at receiving Kasai operation and age at receiving LT were compared among three birth cohorts: (1) 1997 to 2001; (2) 2002 to 2006; and (3) 2007 to 2011.

RESULTS: There were a total of 540 BA cases (275 females) with an incidence of 1.62 per 10000 live births. No seasonality of BA was noted. The mean ages at diagnosis of three cohorts were 57.9, 55.6 and 52.6 d. A linear regression model demonstrated a decreasing trend of the mean age at diagnosis (1.27 d per year). The proportion of BA cases that received the Kasai operation within 60 d of age increased from 76% to 81%. A total of 189 (35%) BA patients underwent LT. The mean age at LT was reduced from 3-year-old to 1-year-old. The rates of LT were 25.6% and 32.3% in patients who received the Kasai operation within 60 d or after 60 d of age, respectively. All patients who did not undergo a Kasai operation eventually required LT.

CONCLUSION: The ages at diagnosis and operation in BA cases have decreased over time. Kasai operation performed at younger age reduces the need for LT. The incidence of BA in Taiwan fluctuates, but without certain trend.

Keywords: Age, Biliary atresia, Kasai operation, Stool color card, Liver transplantation

Core tip: Biliary atresia (BA) is an important liver disease of children. The age of diagnosis and operation for BA greatly affects its outcome. The incidence of BA varies among different studies and long-term trends are controversial. This study found the long-term incidence of BA in Taiwan has no increasing or decreasing trend. The age at diagnosis and operation of BA is continuously decreasing. The mean age at liver transplantation was reduced from 3-year-old to 1-year-old during the 15-year study period.