After the Kasai surgery
Biliary atresia is a rare disease of the liver and bile ducts. It presents very early in life and requires urgent treatment.
In newborns with biliary atresia, bile ducts are missing, incomplete, blocked or damaged. This stops the flow of bile from the liver to the gallbladder and small intestine. Bile backs up and gets trapped inside the liver.
The information on this page is for:
- Parents of babies and children with biliary atresia or suspected biliary atresia.
- Young people with biliary atresia.
- Family, friends, carers, and healthcare professionals.
On this page:
What happens if biliary atresia is not treated?
If a baby does not have a Kasai procedure in the first 2 to 3 months of life, the success rate of the operation is very low. Sadly, a small number of babies are diagnosed late, and a Kasai procedure is not possible. Bile produced in the liver builds up, causing too much damage and scarring in the liver. At this stage, a liver transplant is the only treatment available. In the UK, less than 5% of babies with biliary atresia go straight to liver transplantation.
What happens if the Kasai is unsuccessful?
Even if a Kasai procedure happens in the first few months of life, it is not always successful. In some babies, bile does not drain successfully, and damage keeps happening to the liver. With no other treatment available to stop this ongoing damage to the liver, around 40% of babies and children will need a liver transplant before 2 years of age.
It is important to remember that the Kasai procedure is not a cure for biliary atresia. If successful, it allows some children to live for many years, sometimes decades, with their own liver. But most children will still develop complications that need to be managed. Sometimes, these complications can be severe and may make a liver transplant necessary. Most children will still need a liver transplant at some point in their life.
Just over half of children with biliary atresia will need a liver transplant within 10 years.
Around 60% of children and young people with biliary atresia will need a liver transplant by 20 years of age.
I know a lot of families will be heartbroken to hear that their child may need a liver transplant or that a Kasai procedure may fail, as it did for us. But this does not mean it is the end of their child’s life. We welcomed the idea of a transplant because we knew it would change his life for the better. Families should know that children can go on to live very healthy, normal lives, grow up, and even have families of their own.
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This content was last reviewed: July 2026
Our expert reviewers:
We would like to thank everyone who helped with creating and reviewing this page. Including Professor Mark Davenport, Consultant Paediatric Surgeon, King’s College Hospital and Professor Deirdre Kelly, Professor of Paediatric Hepatology. And all our patient reviewers.
Find out how we make our patient information.
Everyone’s experience of liver disease will be different. Always talk to your specialist medical team for personal advice.
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