After the Kasai procedure, it's crucial to monitor the child for certain signs and symptoms that could indicate complications. The Kasai operation alters the anatomy by using a segment of the bowel for bile drainage, which can increase the risk of infection, particularly a serious condition called ascending cholangitis. Here’s what you need to watch for and how to respond:
Key Risks and Symptoms to Monitor

Fever:
Action: If your child develops a fever and it can't be explained by common illnesses like a sore throat, ear infection, or flu, it’s critical to seek medical attention immediately. Fever in a child post-Kasai could indicate ascending cholangitis, and prompt treatment is necessary.
Response Time: While not immediately life-threatening, it’s important to have your child seen within hours, preferably the same day. You don't need to call an ambulance, but don’t wait until the weekend or delay seeking care.

Increase in Jaundice:
Action: A return or worsening of jaundice (yellowing of the skin or eyes) could indicate that the liver is struggling or that bile is not draining properly. This is another sign that requires prompt evaluation.

Signs of Infection or Poor Feeding:
Action: If your child shows signs of infection, is not feeding well, or is not gaining weight as expected, these could also be signs of a problem that needs medical attention.

Post-Operative Monitoring

Regular Check-Ups: Follow-up care involves regular monitoring of bilirubin levels, liver function tests, and growth. It’s essential to track how well the Kasai is working over time.
Prophylactic Antibiotics: For the first year after the Kasai, your child may be prescribed antibiotics to prevent ascending cholangitis.
Nutrition: Continuing to optimize nutrition is vital, including maintaining the right balance of calories, fats, and vitamins (A, D, E, and K) to support growth and liver function.

Outcomes of the Kasai Procedure

Success Rates:
One-Third of Cases: In about one-third of cases, the Kasai procedure is highly successful, with bilirubin levels normalizing within a few weeks. These children may live many years without needing a liver transplant, though ongoing monitoring remains crucial.
Partial Success: Another third may experience partial success, where bilirubin levels drop but do not normalize completely. These children may need a liver transplant later in childhood, often around the ages of 3-4 years.
Limited or No Success: In the remaining third of cases, the Kasai may not work well, and the child may require a liver transplant within the first year of life, sometimes as early as 8-12 months.

Long-Term Outlook

Even if the Kasai is initially successful, there remains a possibility that liver function may decline over time, necessitating a transplant later in childhood or adolescence. Regular monitoring is essential to catch any signs of liver compromise early.

Being vigilant about these symptoms and maintaining close communication with your healthcare team are the best ways to ensure your child’s health and well-being after the Kasai procedure