Surgical outcome and etiologic heterogeneity of infants with biliary atresia who received Kasai operation less than 60 days after birth

Song, Zai; Dong, Rui; Shen, Zhen; Chen, Gong; Yang, Yifan; Zheng, Shan

doi:10.1097/md.0000000000007267

Cited by 36 publications

(23 citation statements)

References 27 publications

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“…[3][4][5][6][7][8] Several studies have proposed that early diagnosis and treatment is key to the restoration of bile flow and favorable prognosis. [9][10][11][12][13] However, many other non-BA cholestatic diseases, such as idiopathic cholestasis, Alagille syndrome, and progressive familial intrahepatic cholestasis, are similar to BA in symptoms and noninvasive laboratory and radiologic test results, leading to difficulties in the accurate diagnosis of BA. Our previous retrospective study showed that 14% of 602 patients with BA-like neonatal jaundice were found to be non-BA by using invasive diagnostic procedures such as intraoperative cholangiography and liver biopsy.…”

Section: What This Study Addsmentioning

confidence: 99%

Serum MMP-7 in the Diagnosis of Biliary Atresia

et al. 2019

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BACKGROUND: The overlapping features of biliary atresia (BA) and other neonatal cholestasis with alternative causes (non-BA) have posed challenges for diagnosis. Matrix metalloproteinase-7 (MMP-7) has been reported to be promising in diagnosing BA. We aimed to validate the diagnostic accuracy of MMP-7 for BA in a large population sample. METHODS: We enrolled 288 patients with neonatal obstructive jaundice from March 2017 to October 2018. Serum MMP-7 levels were measured by using an enzyme-linked immunosorbent assay. Receiver operating characteristic curves were constructed, and decision curve analysis was done. A Pearson correlation coefficient test was conducted to assess the correlation between MMP-7 levels and other characteristics. RESULTS: The median serum MMP-7 levels were 38.89 ng/mL (interquartile range: 22.96-56.46) for the BA group and 4.4 ng/mL (interquartile range: 2.73-6.56) for the non-BA group (P , .001). The area under the receiver operating characteristic curve value was 0.9829 for MMP-7, and the sensitivity, specificity, positive predictive value, and negative predictive value were 95.19%, 93.07%, 97.27%, and 91.43%, respectively, at a cutoff value of 10.37 ng/mL. When MMP-7 was combined with g glutamyl transferase, the diagnostic accuracy was slightly improved without significance when compared with MMP-7 alone and had an area under the curve of 0.9880 (P = .08). Decision curve analysis also showed potential for MMP-7 to be used for clinical applications. A significant correlation was found with fibrosis stage from liver biopsy (R = 0.47; P , .001). CONCLUSIONS: MMP-7 demonstrated good accuracy in diagnosing BA and holds promise for future clinical application. Furthermore, its correlation with liver fibrosis indicated its potential use as a therapeutic target or prognostic biomarker.

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Section: What This Study Addsmentioning

confidence: 99%

Serum MMP-7 in the Diagnosis of Biliary Atresia

et al. 2019

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“…The prevalence of BA in the Chinese population is higher comparing to the Caucasian population [9]. At the same time, the rate of cytomegalovirus infection in Chinese population is also higher than in western countries.…”

Section: Discussionmentioning

confidence: 81%

Features and prognosis of cytomegalovirus-associated biliary atresia: a retrospective study

Wang

Guan

et al. 2020

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Purpose To investigate the relationship between cytomegalovirus (CMV) infection and biliary atresia (BA) onset, development and short-term prognosis after Kasai operation. Methods A retrospective study was conducted. BA Patients with obstructive jaundice and tested for CMV infection were included and grouped by CMV-IgM and CMV-DNA test results, between-group differences of preoperative blood tests and short-term prognosis indicators were investigated for the statistical significance. Results the CMV infection rate was higher in BA patients compared with non-BA jaundiced patients. Higher preoperative gamma-glutamyl transferase (GGT) level and lymphocyte percentage (Lym%) were significantly corelated with the CMV infection in BA patients. CMV(+) BA Patients had similar short-term outcome comparing with CMV(-) patients. IgM(+)DNA(+) group had highest GGT, total bilirubin (TBiL) and direct bilirubin (DBiL) level. IgM(-)DNA(+) group had the lowest GGT and the highest alkaline phosphatase (ALP) level. IgM(+)DNA(-) group had the highest bodyweight and lymphocyte percentage. The IgM (+)DNA (-) group had more patient achieved complete jaundice clearance than other groups. Conclusion CMV infection may associate to BA development and progression. Perioperative antivirus treatments may be necessary for improving outcome. Better elucidation of the underlying mechanism will require further investigation.

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“…A young age, especially <60 days old at KPE, has been widely, although not universally, linked to improved outcome in BA, which may be explained by the milder liver fibrosis in younger patients ( 16 , 39 – 41 ). However, Song et al ( 42 ) demonstrated that BA patients younger than 40 days had a poorer NLS rate and that, in these patients, severe liver fibrosis may account for the reverse consequence ( 35 , 39 ). Interestingly, our results showed that age at KPE had no significant impact on prognosis of BA.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Perioperative Complications in the Management of Biliary Atresia

Wang

Tang

et al. 2020

Front. Pediatr.

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Purpose: To analyze the influence of perioperative complications in the management of biliary atresia (BA). Methods: A retrospective study was performed using a total of 422 BA patients who underwent Kasai portoenterostomy (KPE) in a single institution between February 2016 and May 2017. Data on patients' clinical characteristics, laboratory examinations, perioperative complications, and outcomes were collected. Unpaired two-tailed t-test and χ 2 test were employed for the comparison between BA patients with and without perioperative complications. Cox regression analysis was used to screen the risk factors for 2-years NLS in BA, and their influence on the 2-years NLS was analyzed using Kaplan-Meier survival analysis as well as the log-rank test. Results: The incidence of perioperative complications, 6-months jaundice clearance (JC) and 2-years native liver survival (NLS) rate were 60.4, 59.5, and 56.6%, respectively. Patients with perioperative complications had lower serum albumin (ALB) level, but higher aspartate aminotransferase-to-platelet ratio index (APRI) and international normalized ratio (INR) levels when compared with those without perioperative complications (ALB, P < 0.05; APRI, P < 0.01; INR, P < 0.05). Moreover, perioperative complications were correlated with glucocorticoid administration (P = 0.002). Univariate Cox regression analysis showed no relationship between perioperative complications and 2-years NLS (P > 0.05). However, multivariate Cox regression analysis indicated 6-months JC was an independent protective factor for 2-years NLS [P < 0.0001, hazard ratio (HR) = 0.074, 95% confidence interval = 0.05-0.11], and concordance index of this prediction model including age, weight, APRI, glucocorticoid, and 6-months JC was 0.811. Conclusion: Although perioperative complication is common during and after KPE, it had no influence on the prognosis of BA. However, assessment of the serum level of total bilirubin after KPE may serve as an important predictor for the outcome in BA.

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Surgical outcome and etiologic heterogeneity of infants with biliary atresia who received Kasai operation less than 60 days after birth

Cited by 36 publications

References 27 publications

Serum MMP-7 in the Diagnosis of Biliary Atresia

Serum MMP-7 in the Diagnosis of Biliary Atresia

Features and prognosis of cytomegalovirus-associated biliary atresia: a retrospective study

Evaluation of Perioperative Complications in the Management of Biliary Atresia

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