Abstract
BackgroundThe progression of hepatic fibrosis may result in decompensated hepatic failure with cirrhosis, liver related events (LRE) such as ascites, variceal bleeding, and death after successful and timely Kasai hepatoportoenterostomy (HPE) in biliary atresia. The aim of this study is to suggest clinical benefit of the liver stiffness measurement (LSM) using transient elastography at 3 months after the Kasai operation to predict LRE.MethodsBetween January 2007 and December 2011, 69 eligible biliary atresia patients who underwent Kasai HPE and performed transient elastography before and 3 months after HPE were included. The occurrences of LRE were analyzed for all patients. All patients were divided into 2 groups (with and without LRE) for comparison. Multivariate analysis was used to detect the independent risk factors of LRE. The area under the receiver operation characteristics curve (AUROC) was used to establish the LSM optimal cutoff value of 3 months after Kasai operation in predicting LRE.ResultsLSM value, aminotransferase, albumin, bilirubin, and PT-INR significantly differed among the two groups. Multivariate analysis demonstrated LSM value as the most powerful independent factor of the development of LRE. The cut-off value of 19.9 kPa was calculated to be optimal for predicting LRE development with total sensitivity and specificity of 1.804. AUROC resulted in 0.943, with sensitivity of 85.3% and specificity of 95.2%.ConclusionsThe LSM value of 3 months after Kasai HPE can be a useful predictor of LRE development.
Highlights
Since the introduction of hepatoportoenterostomy (HPE) by Dr Kasai in the 1950s, it has been the treatment of choice for biliary atresia patients
More than 90% of patients undergo Kasai HPE after diagnosis of biliary atresia while some patients with progressed end stage liver disease chose the transplantation first, liver transplantation is performed during follow-up on up to 50% of children who already had the Kasai operation
Progression of subclinical compensated liver disease may result in decompensated hepatic failure with cirrhosis, liver related events (LRE) such as ascites, variceal bleeding, hepatic encephalopathy and death
Summary
Since the introduction of hepatoportoenterostomy (HPE) by Dr Kasai in the 1950s, it has been the treatment of choice for biliary atresia patients. More than 90% of patients undergo Kasai HPE after diagnosis of biliary atresia while some patients with progressed end stage liver disease chose the transplantation first, liver transplantation is performed during follow-up on up to 50% of children who already had the Kasai operation. Progression of subclinical compensated liver disease may result in decompensated hepatic failure with cirrhosis, liver related events (LRE) such as ascites, variceal bleeding, hepatic encephalopathy and death. Clinical features and laboratory data can be helpful, definitive diagnosis of hepatic fibrosis and cirrhosis is classically performed with a histological examination of liver tissue obtained from a liver biopsy. The progression of hepatic fibrosis may result in decompensated hepatic failure with cirrhosis, liver related events (LRE) such as ascites, variceal bleeding, and death after successful and timely Kasai hepatoportoenterostomy (HPE) in biliary atresia. The aim of this study is to suggest clinical benefit of the liver stiffness measurement (LSM) using transient elastography at 3 months after the Kasai operation to predict LRE
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