Nationwide outcomes of biliary atresia after Kasai portoenterostomy in Taiwan: the impact of postoperative cholangitis and corticosteroid use

Purpose To provide updated nationwide outcomes of biliary atresia (BA) among patients in Taiwan, focusing on postoperative cholangitis, liver transplantation (LT), corticosteroid use, and renal outcomes. Methods Infants with BA who underwent Kasai portoenterostomy were identified from the Taiwan National Health Insurance Research Database (2008–2019). Postoperative outcomes were evaluated, and the association between cholangitis episodes and LT was analyzed using exploratory logistic regression analysis. Corticosteroid exposure was categorized by duration, and acute kidney injury was assessed as a secondary outcome. Results This study included 334 infants. Acute cholangitis occurred in 76.3% of cases, with 24.9% experiencing ≥ 5 hospitalizations. A greater number of cholangitis episodes was associated with a higher likelihood of LT (odds ratio: 1.08, 95% confidence interval: 1.00–1.16, p = 0.044). Approximately 30.8% of patients developed biliary cirrhosis, and 33.8% received LT. Corticosteroids were prescribed to 96% of patients, and a longer treatment duration was associated with higher complication rates. About 1.8% of patients developed acute kidney injury, with no progression to end-stage renal disease. Conclusion Postoperative cholangitis remains an important clinical factor associated with LT in infants with BA. Corticosteroid treatment duration may reflect underlying disease severity rather than therapeutic benefit. Renal complications are uncommon. Optimizing postoperative care—particularly timely cholangitis management—is essential to improve outcomes.