Title: Clinical features of biliary atresia complicated by cytomegalovirus infection and prognostic analysis after Kasai portoenterostomy
Source: Journal of Pediatric Surgery 2026, May 8. [E–publication]
Date of publication: May 2026
Publication type: Retrospective study
Abstract: Objective: To explore the unique clinical characteristics of biliary atresia(BA)combined with cytomegalovirus infection and its impact on early and late prognosis after Kasai portoenterostomy(KPE).
Methods: This was a retrospective study involving children diagnosed with BA and treated with KPE at the Children’s Hospital of Jiangxi Province from January 2017 to October 2023. Based on the presence or absence of CMV infection, the patients were divided into a CMV infection group and a CMV non-infection group. The follow-up period ended on October 1, 2025, with a minimum follow-up duration of >2 years. Data were collected and analyzed, including basic characteristics, core disease features, core laboratory indicators, treatment-related indicators, surgical success within 3 months postoperatively, and native liver survival status after more than 2 years.
Results: A total of 70 BA patients were included, with 19 in the CMV infection group and 51 in the CMV non-infection group. In the CMV infection group, 31.6% (6/19) had successful surgery, while in the non-infection group, 47.1% (24/51) had successful surgery. In the CMV infection group,78.9% (15/19) experienced native liver failure (NLF), whereas in the non-infection group, 51.0% (26/51) experienced NLF. Differential analysis showed significant differences between the CMV infection group and the non-infection group in terms of age at admission, surgical age, hepatomegaly, surgical weight, GLO levels, AST levels, DBIL levels, gallbladder ejection fraction, postoperative antiviral treatment (P < 0.05), while no significant differences were found in gender, ALB, ALP, ALT, GGT, PLT, Splenomegaly, BASM, other associated malformations, BA anatomical classification, early postoperative cholangitis, and total postoperative steroid dose (P > 0.05). Univariate and multivariate analyses showed that CMV infection is an independent risk factor for long-term NLF postoperatively (HR = 1.988, 95% CI: 1.005,3.932, P = 0.049), but it had no significant effect on the short-term success rate of KPE (OR = 2.118, 95% CI: 0.644,6.967, P = 0.217). Kaplan Meier plotter showed that the cumulative incidence of NLF events was significantly higher in the CMV infection group, and the median native liver survival time was significantly shorter (Log-Rank P < 0.05).
Conclusion: BA patients with CMV infection exhibit clinical features such as delayed diagnosis and more severe liver damage. CMV infection does not specifically cause gallbladder “absence” or “functional abnormality” as a single defect, but rather more broadly interferes with the normal development of the biliary system, making it difficult for children to maintain an ideal state of “structurally intact and functionally normal.” Although CMV infection does not affect the early success rate of KPE, it is an independent risk factor for long-term NLF, significantly reducing the long-term survival rate of native liver in BA patients. Therefore, in the future, CMV status can be used as an important indicator for risk stratification and long-term follow-up of BA patients.
