Cross-sectional study of liver fibrosis and biochemical trends after Kasai operation in patients with biliary atresia

Abstract

Objective To explore the trends of liver fibrosis and biochemistry after Kasai operation in patients with biliary atresia (BA). Methods A cross-sectional study was performed from January 2013 to December 2013 and clinical follow-up data were collected. All 121 patients were included with postoperative time longer than 6 months. They were divided into three groups of excellent, favorable and poor according to jaundice-free duration after Kasai operation with cut-off points of 3 and 6 months. Age at Kasai operation, Fibroscan value and biochemical results before and after Kasai operation were statistically analyzed and tendency charts plotted. Results There were 69 males (57.0%) and 52 females (43.0%). Three groups were excellent 63(52.1%), favorable 34(28.1%) and poor 24(19.8%). No statistical difference in age at Kasai operation existed among three groups. The Fibroscan values of three groups fluctuated with 1 year after Kasai operation and stabilized gradually after 1 year. One-way ANOVA and rank-sum test showed statistical difference between excellent-good and poor groups within 1 year after Kasai operation. However no difference existed between excellent and good groups. Total bilirubin (TB) of excellent-good group decreased significantly in the first 3 months, declined slowly and TB became stable within a normal range. TB of poor group decreased significantly in the first 2 months with major fluctuations thereafter. Alanine transaminase (ALT) peaked at 1 month. And it decreased without stabilization within 6 months in excellent-good group. In poor group, it could not achieve stabilization. Aspartate transaminase (AST) of three groups decreased within 6 months but couldn't achieve stabilization thereafter. Gamma glutamyl transferase (GGT) of three groups peaked at 1 month, declined quickly within 6 months with minor fluctuation and became stabilized. Conclusions Liver fibrosis may progress within 1 year after Kasai operation in BA. The liver fibrosis status of survivors with native liver becomes stable and progresses slowly after 1 year. And it becomes more stable after 2 years in excellent group. TB decreases most significantly within 1 month after Kasai operation. And patients jaundice-free within 3-6 months can achieve long-term normal TB level. Liver inflammation, ductular reaction and liver function damage progress after Kasai operation. Improvement occurs after 1 month and stabilizes after 6 months. Key words: Biliary Atresia; Liver cirrhosis; Biological markers