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The comments expressed in the communication from Lowell et al go right to the core of the biliary atresia controversy. Should the infants with this disease undergo a portoenterostomy or primary liver transplantation? While we acknowledge that the Kasai operation is an imperfect solution, the question is, how can we best identify those patients who are most likely to benefit from it? Unfortunately, our article1 was not intended to answer the question. However, our group has written numerous publications addressing prognostic factors in biliary atresia.2,3 We have demonstrated the prognostic importance of age at operation; bile duct histologic features; liver biopsy findings (fibrosis or cirrhosis, parenchymal degeneration, and giant cell transformation); and postoperative factors, such as bile drainage, cholangitis, portal vein velocity, variceal hemorrhage, and ascites. We chose in our article not to reiterate those previously published results but to focus our review on the long-term
Karrer FM. Long-term Results With the Kasai Operation for Biliary Atresia-Reply. Arch Surg. 1996;131(11):1235. doi:10.1001/archsurg.1996.01430230117026