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. 2019 May;5(2):155-160.
doi: 10.5114/ceh.2019.85072. Epub 2019 May 13.

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

Samira Abdel-Wahab Abdel-Aziz  1 , Mostafa Mohamad Sira  1 , Emad Hamdy Gad  2 , Islam Ayoub  2 , Mervat Soltan  3
Affiliations

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

Samira Abdel-Wahab Abdel-Aziz et al. Clin Exp Hepatol. 2019 May.

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.

Keywords: Kasai hepatoportoenterostomy; age; alkaline phosphatase; outcome.

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Conflict of interest statement

Authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Performance of age (A) and alkaline phosphatase (B) in discriminating between biliary atresia (BA) patients with successful and those with failed Kasai
See this image and copyright information in PMC

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