A nomogram for predicting early- and mid-term native liver survival after surgery in patients with type III biliary atresia: a single-center retrospective study

BACKGROUND: Biliary atresia (BA) is a severe obstructive biliary disease. This study aimed to explore the independent risk factors influencing the prognosis of BA in children who underwent Kasai portoenterostomy (KPE) and to construct a nomogram for predicting the prognosis. METHODS: The clinical data of patients with type III BA who underwent KPE at Guangzhou Women and Children's Medical Center from June 2016 to May 2024 were retrospectively analyzed. Univariate and multivariate Cox regression analyses were used to screen for independent risk factors. A nomogram was constructed using the screened variables to predict postoperative early- and mid-term native liver survival (NLS). The predictive efficacy of the model was evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curve and area under the curve (AUC), and calibration curves. RESULTS: Two hundred patients with type III BA whose clinical data were available were randomly divided into training and validation cohorts at a ratio of 7:3. Age at surgery, recurrent cholangitis, early bile drainage (EBD), and aspartate aminotransferase (AST) level within 1 month after surgery were identified as independent risk factors (all P < 0.05), and a nomogram was constructed using these factors. The C-index was 0.76 (95% CI: 0.71, 0.80) for the training cohort and 0.69 (95% CI: 0.57, 0.75) for the validation cohort. Excellent discrimination and calibration were observed for both groups. CONCLUSION: The nomogram constructed using variables such as age at surgery, recurrent cholangitis, EBD, and postoperative AST level can accurately predict the probability of NLS after surgery, providing a quantifiable assessment tool for clinical individualized clinical management.