Preoperative alkaline phosphatase is a potential predictor of short-term outcome of surgery in infants with biliary atresia

Abstract

Aim of the study Biliary atresia (BA) is a fibro-inflammatory cholangiopathy of intra- and extrahepatic biliary radicles. The standard-of-care treatment is surgical restoration of bile flow by Kasai hepatoportoenterostomy (HPE). We aimed to identify the predictors of short-term outcome of the Kasai operation three months postoperatively. Material and methods This retrospective study included 107 infants diagnosed with BA by intraoperative cholangiography. All underwent a Kasai operation. The surgical outcome was classified after 3 months post-operatively as successful (bilirubin ≤ 2 mg/dl) or failed (bilirubin > 2 mg/dl). The two groups were compared according to basic clinical, ultrasonographic and histopathological characteristics. Results Of the studied patients 29 (27.1%) had a successful outcome while 78 (72.9%) had failed Kasai HPE. Of the preoperative characteristics, lower age and lower serum alkaline phosphatase (ALP) were significantly associated with successful surgical outcome ( p = 0.009 and < 0.0001, respectively). In addition, surgical type of BA affected the short-term outcome ( p = 0.017), while there was no statistically significant difference regarding the other studied parameters between groups. Age of 69.5 days or less was predictive of successful outcome with 74.4% specificity but with low sensitivity (58.6%), and ALP at a cutoff level of 532.5 U/l or less was predictive of successful outcome with 75.9% sensitivity and 74.4% specificity. Conclusions Younger age at the time of surgery and lower ALP are good predictors for the short-term outcome of Kasai HPE with better performance of ALP. This may help to anticipate those who can benefit from surgical correction and those who should be given high priority for transplant referral.

Short- and long-term outcomes after Kasai operation for type III biliary atresia: Twenty years of experience in a single tertiary Egyptian center-A retrospective cohort study

“…steroids) in those literature studies. On the other hand, it was only 27.1% in our previous study due to the difference in jaundice resolution time (3 months), patient NO, and study period [ 40 ].…”

Clinical Findings in Biliary Atresia: A Literature Review

“…Patients with biliary atresia typically exhibit elevated levels of conjugated bilirubin, a slight increase in serum gamma-glutamyl transferase (GGT), ALP, and elevation in serum transaminases [17]. The increase in conjugated bilirubin is indicate of liver cell damage or cholestasis.…”

Combined Predictors of Long-Term Outcomes of Kasai Surgery in Infants with Biliary Atresia

“…Earlier reports emphasized significantly lower preoperative blood levels of ALP activity in patients with efficacious Kasai procedure than those without (400.9±253.3 U/L vs. 586.7±274.9 U/L, p =0.004 and 410.7±177.76 U/L vs. 701.7±322.5 U/L, p <0.0001) [ 13 27 ]. In our setting, these indicators had negligible predictive utility in the binary logistic regression models, although their contributions are theoretically feasible and can be refined for larger cohorts.…”

“…The major known factors for adverse outcomes in HPE are patient age at surgery (>3 months) and the syndromic forms of BA [ 11 ]. The outcomes have also revealed certain associations between biochemical markers [ 12 13 14 ] and histopathological indicators, including fibrosis [ 15 16 17 ], inflammation [ 18 ], and bile duct diameter [ 19 ]. The scope of the candidate predictors is limited, and the results obtained thus far require additional reflection and refinement.…”