How Do I Choose a Kasai Center for Biliary Atresia?

If your baby has been diagnosed with isolated biliary atresia—meaning the bile ducts are blocked or absent, but your baby does not have other congenital abnormalities like spleen or heart issues—choosing where to have the Kasai procedure (portoenterostomy) is a critical step. The Kasai procedure creates a new pathway for bile to drain from the liver into the intestines.

Research shows that infants treated at specialized centers often have better outcomes, such as earlier jaundice clearance (when the yellowing of skin and eyes resolves because bile is draining) and a longer period of surviving with their native liver (their own original liver) ^[1][2]. However, you do not have to figure this out alone. The most important action you can take is to ask your current doctor for an urgent, clinician-to-clinician referral to a specialized pediatric hepatobiliary (liver and bile duct) center.

What to Do Right Now

Because biliary atresia is time-sensitive, do not delay care while trying to research the “perfect” hospital ^[3].

• Request an urgent referral: Ask your current doctor to contact a specialized center immediately to coordinate a transfer, send medical records, and arrange an evaluation.
• Prioritize speed and expertise: A specialized center that can evaluate and operate on your baby within days is generally preferable to waiting weeks for an appointment at a different hospital ^[3].

How to Evaluate a Center’s Experience

Because biliary atresia is a rare condition, no hospital performs hundreds of Kasai procedures a year, and there is no universally agreed-upon number that officially makes a center “high-volume” ^[1][4].

Some research studies have noted that hospitals performing more than 3 to 5 of these procedures per year, and surgeons who have performed 20 to 40 in their career, sometimes report better outcomes ^[1][5][6]. However, these numbers are observations from specific studies, not official safety cutoffs. Rather than looking for a strict number, look for a major children’s hospital with a dedicated, experienced team that regularly treats pediatric liver diseases.

The Balance Between Expertise and Timing

The timing of the Kasai procedure is critical. While it is not an absolute emergency that must happen tonight, it is urgent. Outcomes are generally best when the surgery is performed as early as safely possible, often with a goal of before 60 days of life ^[7][8]. A later diagnosis does not mean treatment is futile, but earlier surgery is consistently associated with better bile drainage and a higher chance of delaying a liver transplant ^[7].

When choosing a hospital, you must weigh the benefits of a distant hospital’s experience against the time it will take to arrange the transfer. Consider traveling to a major children’s hospital if local options are limited, but make sure the travel arrangements do not severely delay the surgery.

Building Your Care Team

The Kasai procedure is just the first step in a lifelong journey. You are choosing a long-term multidisciplinary care team ^[9][10]. This team should include:

• Pediatric Surgeons: Specialists who regularly perform complex infant liver and bile duct surgeries.
• Pediatric Hepatologists: Liver specialists who will manage your child’s liver health, medications, and laboratory monitoring for years after the surgery ^[11].
• Pediatric Nutritionists: Because poor bile flow causes reduced absorption of fat and fat-soluble vitamins (A, D, E, and K), specialized nutritional support is essential for your baby’s growth and development ^[12][10].
• Pediatric Liver Transplant Access: Even if the Kasai procedure is successful, many children will eventually need a liver transplant ^[13]. The hospital should either have its own pediatric transplant program or a formalized, rapid referral pathway to one ^[9]. This is vital if your child develops complications like cholangitis (bacterial infections of the bile ducts), poor growth, or portal hypertension (high blood pressure in the vein system that carries blood to the liver) ^[13][14].