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Post-hepatoportoenterostomy Acoustic Radiation Force Impulse Elastography to Predict Two-year Outcome of Biliary Atresia

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Journal of Clinical and Translational Hepatology 2023年第3期11卷 595-604页

作者： Dongying Zhao Yahui Li Wei Xie Wenjie Wu Yan Chen Yongjun Zhang Department of Neonatology Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina Department of Pediatric Surgery Intensive Care Unit Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina Department of Pediatric Surgery Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina

Background and Aims: Early identification of prognostic factors to predict transplant/death outcome of biliary atresia (BA) is challenging. We aimed to investigate the longitudinal changes and predictive value of dynamic changes in acoustic radiation force impulse elastography with shear wave speed (SWS) quantification and other parameters within three months after hepatoportoenterostomy (HPE) for 2-year BA outcomes. Methods: Seventy-four patients who underwent HPE between July 2016 and June 2019 were prospectively enrolled. Outcomes were classified into native liver survival and transplant/death groups. Acoustic radiation force im-pulse elastography was performed sequentially at 3 months intervals post-HPE. Cox regression analysis was used to de-termine the superior SWS values and other predictors of liver transplantation or death. Results: Among patients 2 years of age, 36 survived with a native liver, nine died, and 29 underwent liver transplantation. The trend in SWS levels in the transplant/death group was significantly different from that in the native liver survival group. ΔSWS at 1-3 months post-HPE and total bilirubin at 1 month post-HPE were se-lected as superior predictors of liver transplantation or death using multivariate Cox regression models: hazard ratio (HR)=1.927;95% confidence interval (CI): 1.475-2.661;p<0.001 and HR=1.010;95% CI: 1.003-1.017;p=0.007, respectively. The combination of the selected ΔSWS and total bilirubin had good predictive power, with an area under the receiver operating characteristics curve of 0.89, specificity 94.44% and sensitivity 73.68%. Conclusions: Our results suggest that early postoperative bilirubin levels and SWS changes were reliable predictors of 2-year BA outcomes.

关键词： Biliary atresia hepatoportoenterostomy Acoustic radiation force impulse elastography Native liver survival Liver transplantation.

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