Late Presentation, Diagnostic Delay With No Facility for Liver Transplantation of Biliary Atresia Cases in Bangladesh: Experience of 103 Cases in a Tertiary Care Hospital

Abstract

Background: Biliary atresia is an important cause of neonatal cholestasis, which needs timely diagnosis for a satisfactory outcome after the Kasai procedure. It has been reported that bile flow has been re-established in more than 80% of infants who were referred for surgery within 60 days of birth, the success rate drops dramatically to under 20% in those older than 90 days at the time of operation. The study aims to observe age at presentation, at diagnosis after hospital evaluation,the number of cases referred for Kasai before 60 days of age,and the clinicobiochemical  findings of biliary atresia cases attending a tertiary care hospital in Bangladesh.

Materials and methods: This was a retrospective crosssectional observational study from hospital records, approved by the ethical committee of the Pediatric Gastroenterology Department of Bangladesh Medical University (BMU) Dhaka, Bangladesh. The study was conducted from January 2018 to January 2022, after approval from the departmental ethical board. A totalof 184 cases of neonatal cholestasis were admitted, among them, 103 were diagnosed as BA

Results: We found that only 21.45% of biliary cases were reported before 60 days of age, while 79% of cases were reported after 60 days of birth. The mean age at presentation was 92±41 days, with an additional 11.8±3.7 days needed for hospital evaluation. Only 32% of cases underwent the Kasai procedure, including both age groups.  

Results: As there is no facility for liver transplantation currently in Bangladesh, patients of biliary atresia with failed/no Kasai procedure, especially from low-income groups faces a worse prognosis in late infancy. Late diagnosis from various factors, including late referral with long hospital evaluation time and no facility for liver transplantation, are the main obstacles forthe management of biliary atresia cases in Bangladesh. Raising awareness for early diagnosis and the establishment of a liver transplantation center at the government level would be the priorities for a better outcome of biliary atresia patients in Bangladesh.

JCMCTA 2026 ; 37 (1) : 50-54