Biliary Atresia

Biliary atresia is a rare, life-threatening liver disorder in newborns—estimated at 1 in 8,000 to 18,000 live births worldwide—and is more common in females and children of Asian or African American descent. Our Pediatric Liver Center care team has deep expertise in treating children with this rare condition, and our Stanford Medicine Children’s Health team has been providing specialized care for more than 30 years. As a trusted referral center for the West Coast, we are well known for our innovative, advanced, and timely care for biliary atresia, which gives babies their best chance at a healthy future.

Biliary atresia care highlights at Stanford Medicine Children’s Health

• Care from experts in the liver and gallbladder. Biliary atresia requires care from highly specialized doctors, called hepatologists (liver doctors). Only large, comprehensive centers like ours have hepatologists who are dedicated to treating biliary atresia in children. While biliary atresia is a rare disease, it is familiar to our liver doctors at Stanford Children’s Health.
• Timely diagnosis and treatment for better outcomes. Getting a diagnosis and a Kasai procedure to treat biliary atresia early in the disease course is critical for helping your child achieve better health in their lifetime. To correctly identify biliary atresia soon after birth, our doctors developed a cutting-edge screening tool that is used to universally screen all our newborns. This enables early diagnosis and allows us to complete the Kasai surgery within 30 days of life, which is the ideal timeline to allow for the best outcomes.
• Care based on leading-edge research. Stanford Children’s has an established national reputation for exceptional research on liver conditions. We are also conducting clinical trials on biliary atresia to improve care, and we work closely with Biliary Atresia Research & Education (BARE), which further enables us to improve our biliary atresia outcomes.
• Smooth transition to liver transplant. Biliary atresia is the No. 1 reason for liver transplant, and more than half of all children born with biliary atresia eventually have a liver transplant. With our deep expertise and multidisciplinary collaboration, we can inform the best timing for liver transplant evaluation. Our biliary atresia doctors are trained transplant hepatologists who will care for your child from the first visit through liver transplantation, and after.
• One of the largest and best liver transplant centers in the U.S. Our Pediatric Liver Transplant program is consistently in the top four in the nation for volumes and excels in three-year liver graft and patient survival rates. We maintain rates that are traditionally the top in the nation.
• Well-rounded care from multiple specialists. We put your child at the center of a multidisciplinary liver care team that’s dedicated to treating biliary atresia, including hepatologists, interventional radiologists, general surgeons, liver transplant surgeons, dietitians, advanced practice providers, and social workers. We also partner with our exceptional Neonatal Intensive Care Unit to treat premature newborns, who are at a higher risk for biliary atresia.

How we treat biliary atresia at Stanford Medicine Children’s Health

At Stanford Children’s, we initiate care for biliary atresia early to help stabilize your infant by managing their liver disease, providing the Kasai procedure quickly, and determining appropriate timing for liver transplant, when needed. We partner closely with your child’s pediatrician throughout the process, as needed.

• To fully diagnose biliary atresia, a liver biopsy and cholangiogram are often needed. Many hospitals perform a surgical procedure to obtain a liver biopsy as a standard practice, but we do not. Instead, we collaborate with Interventional Radiology to make it less invasive and easier on your child, if possible.
• With biliary atresia, your child must have a surgery performed to save their life. The optimal biliary atresia treatment path is a Kasai procedure in the first 30 to 60 days after birth, followed by a pediatric liver transplant (if needed) later on, when your child is bigger, stronger, and more developed.
• The Kasai procedure is a surgery that seeks to connect the liver and intestinal tract so your child’s liver can release toxic bile and avoid further damage. It is performed by our pediatric general surgeons who specialize in the Kasai procedure.
• Leading national biliary atresia organizations recommend intervening with the Kasai as quickly as possible, preferably within the first 30 days—a goal we are often able to reach for babies born at Stanford Children’s.
• Some children can live into adulthood with just a Kasai procedure, as long as there are no signs of liver failure. Many children, however, need a liver transplant at some point in their lifetime.
• A liver transplant is the next intervention for biliary atresia. This occurs when the Kasai is not able to prevent toxic bile from accumulating in the liver, leading to the liver failure. Our Stanford Children’s liver transplant program team is deeply experienced in determining the exact right time for liver transplant—when your child is healthy and strong—and they perform liver transplants for children of all ages, including newborns, and achieve exceptional outcomes. Learn more about our pediatric liver transplantation >   
• Some newborns and infants with biliary atresia fail to thrive and experience poor weight gain. For such patients, we provide expert nutritional support, including special formulas, for biliary atresia to support growth and development.

For referring physicians

If you have a patient you would like to discuss or refer for a biliary atresia evaluation, please call (650) 725-8771 and ask to speak with the hepatologist on call.