Abstract
To the Editor: We read with great interest the article by Kim et al (1) postulating that the aspartate transaminase-to-platelet ratio index (APRI) can be used as a noninvasive, easily available surrogate marker for the severity of liver fibrosis in patients with biliary atresia (BA). The management and outcome of progressive liver conditions is strongly dependent on the severity of liver fibrosis and occurrence of cirrhosis (2), and a noninvasive marker for fibrosis would be of great value in this pediatric population. Using our prospective BA database, we identified all of the patients with BA who had undergone Kasai portoenterostomy (KP) and aimed to correlate APRI with severity of fibrosis (Metavir score) and (transplant-free) survival in patients with BA. We identified 31 patients (n = 35), computed APRI at time of KP, and correlated this with the severity of fibrosis at KP and (transplant-free) survival. Median APRI according to fibrosis grade (F1–4) was F1 1.26 (0.91–5.69), F2 1.41 (0.74–7.18), F3 1.37 (0.80–4.02), and F4 1.33 (0.64–4.77) and was not significantly different (1-way analysis of variance, P = 0.89). Neither overall survival (r = 0.13; P = 0.48) nor transplant-free survival (r = 0.08; P = 0.67) was correlated with APRI. With these data, we are not able to confirm APRI as a suitable surrogate marker for liver fibrosis in BA. Further research needs to be done before APRI can be applied to patients with BA.
Published Version
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