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Insulin-like growth factor-1 (IGF-1) in children with postoperative biliary atresia: a cross-sectional study
Nopaorn Phavichitr1, Apiradee Theamboonlers, Yong Poovorawan
1Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand.
Insights
Children with biliary atresia (BA) who underwent successful Kasai portoenterostomy surgery showed improved growth and nutritional status. Successful surgery correlated with normal height and higher insulin-like growth factor 1 (IGF-1) levels, indicating better outcomes.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Pediatric Surgery
Background:
- Biliary atresia is a primary cause of infantile cholestasis and cirrhosis.
- Kasai portoenterostomy and liver transplantation improve outcomes but growth failure persists.
- Growth failure is a significant complication in children with chronic liver disease.
Purpose of the Study:
- To evaluate growth, nutritional status, and serum IGF-1 in biliary atresia patients post-Kasai operation.
- To compare these parameters between successful and unsuccessful surgical outcomes.
- To identify factors associated with improved clinical outcomes in biliary atresia.
Main Methods:
- Fifty-four children with postoperative biliary atresia were assessed.
- Clinical outcomes, height, nutritional biochemistry, and serum IGF-1 were measured.
- Height and IGF-1 were standardized using standard deviation scores (SDS).
Main Results:
- 44.4% of patients had unsuccessful operations with persistent jaundice.
- Successful Kasai portoenterostomy correlated with normal hematocrit, albumin, calcium, and phosphorus.
- Patients with successful surgery had significantly higher height SDS and IGF-1 SDS compared to those with failed surgery.
Conclusions:
- Successful Kasai portoenterostomy in biliary atresia leads to better growth and nutritional status.
- Higher serum IGF-1 levels are associated with favorable outcomes after biliary atresia surgery.
- Postoperative growth and IGF-1 levels can serve as indicators of surgical success in biliary atresia.
Abstract:
Biliary atresia is the leading cause of chronic infantile cholestasis which eventually leads to cirrhosis. Re-establishment of biliary drainage by Kasai portoenterostomy and liver transplantation for end-stage liver disease has favorably altered the clinical outcome. However, growth failure, one of the major complications of chronic liver disease, remains a major problem. The aim of the study is to evaluate growth, nutritional status and serum growth factor IGF-1 in children with biliary atresia after Kasai operation and at comparing these data between the groups with successful and unsuccessful operation. Fifty-four children with postoperative biliary atresia were evaluated for their clinical outcome, height, blood biochemistry related nutritional status and serum IGF-1. Height and serum IGF-1 were expressed as standard deviation score (SDS) to minimize the influence of age. With 44.4% of the enrolled patients the operation had been unsuccessful and jaundice persisted. The mean age of children with jaundice in comparison with the jaundice free groups was not significantly different (42.0 and 49.9 months, p = 0.458). In jaundice-free patients, hematocrit, serum albumin, calcium and phosphorus were normal and significantly higher. In the successful Kasai group, the height SDS and serum IGF-1 SDS were within the normal range and significantly higher (height SDS 0.2 +/-1.0 vs. -0.9 +/- 1.2, p < 0.01 and IGF-1 SDS 0.5 +/- 2.2 vs. -1.3 +/- 1.0, p < 0.01). The mean IGF-1 SDS in the failed Kasai group was less than -1. Children with good outcome of postoperative biliary atresia showed better growth, better nutritional status and higher serum IGF-1 levels when compared to those with unsuccessful operation.