Assessment Of Liver Fibrosis And Analysis Of Native Liver Survival After Kasai Operation In Patients With Biliary Atresia

Part1Assessment of liver fibrosis in patients with biliary atresiaObjective:This study was designed to discuss the value ofaspartate aminotransferase-to-platelet ratio index（APRI）as aevaluation index of liver fibrosis progression in patients with biliaryatresia.Methods:A total of376patients with BA who underwent the bileduct exploration between March1997and September2012wereanalyzed retrospectively, the clinical data including laboratory testsand histopathologic diagnosis were collected. Hepatic histopathologywere performed using the Okamoto classification and simplified intotwo groups according to clinical and research needs. Screening theindicators which were statistically different between the two groupsand assessing the diagnostic value of the clinical indicators forprediction of early liver cirrhosis. The correlation between APRI and hepatic histopathology and the outcome of the two groups which werebased on APRI werediscussesed in the further research.Result:376patients were enrolled. The total cases were dividedinto2subgroups: no cirrhosis (stage0-III)138patients vs earlycirrhosis (stage IV)238patients. The indexes including Plt, TB, DB,AST, ALT, AST/ALT, ALP, LDH, APRI, INR, PELD and age at operation havesignificant different between the2groups. The AUROC of the APRIwas0.844and the optimal cut-off was1.0, with the sensitivity andspecificity were0.787and0.745. APRI showed moderate correlationwith the gold criterion for liver fibrosis degree (r=0.532, P＜0.001).Clinical outcomes of patients were significantly different betweenthe2groups (no cirrhosis vs early cirrhosis) based on APRI(≤1.0or＞1.0) before and3months after the Kasai procedure.Conclusion:APRI showed moderate correlation with liver fibrosisprogression. APRI might be applied to evaluate liver fibrosisprogression in patients with BA during preoperative management andpostoperative follow-up care. Part2Analysis of native liver survival in biliary atresia after KasaioperationObjective:To analyze the native liver survival after Kasaioperation and the prognostic factors for biliary atresia (BA).Methods：A total of376patients with BA were analyzed,amongthese,193patients received Kasai operation.The clinical andfollow-up data of143patients were collected.Using theKaplan-Meier,Cox regression to analyze the survival rate andprognostic factors.Results:50patients loss to follow-up of193.Accumulation nativeliver survival rate of1,2,3,4-year postoperative were50.3%,39.9%,33.7%,28.1%. The long-term survival after Kasai operationwas found to correlate with cholangitis and hormone therapy, howeverdo not include CMV infection,age at operation and type of BA. The average age of specialisttreatment for the first time and surgery were (82±44)d and(92±42)d in376patients,while (67±27)d and (76±28)d in193patientswho were underwent Kasai.Conclusion:The curative effect after Kasai is still poor,standardized hormone therapy and postitive treatment of cholangitisare the important factors to improve the long-term survival. Setting up integrated jaundice screening, diagnosis and treatmentsystems,all these are also important measures to improve thelong-term survival after Kasai operation.