Prognostic Outcomes by Ishak Fibrosis Score Grouping in Biliary Atresia after Kasai Surgery: A Prospective Study

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 at the Affiliated Hospital of Zunyi Medical University from 2019 to 2023. Based on postoperative Ishak scores, patients were categorized into the Mild Fibrosis Group (Ishak 1–2, n = 20), the Moderate Fibrosis Group (Ishak 3–4, n = 39), and the Cirrhosis Group (Ishak 5–6, n = 24). Follow-up data, including clinical information and liver function tests, were compared six months postoperatively. Results Baseline characteristics (age, sex, weight) showed no intergroup differences (P > 0.05). Median surgical ages: mild (76 days, IQR 54.8–92), moderate (70 days, IQR 53–87), cirrhosis (90 days, IQR 59–118.5). Generalized estimating equations (GEE) revealed time-dependent declines in ALT, AST, ALP, and Total Bile Acids (TBA) across groups ( P  < 0.05), with cirrhosis patients exhibiting higher GGT and bilirubin levels vs. mild fibrosis ( P <  0.05). Three-month Clearance of Jaundice (CoJ) differed significantly: 55.0% (mild) vs . 38.5% (moderate) vs. 8.3% (cirrhosis) (χ²=11.363, P =  0.003). Six-month NLS sharply declined with fibrosis severity: 80.0% (mild) vs. 16.7% (cirrhosis) (χ²=19.714, P < 0.001). Multivariate logistic regression identified lower Ishak scores (OR = 0.463, 95% CI:0.287–0.746) and younger surgical age (OR = 0.965, 95% CI: 0.936–0.994) 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.