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Extrahepatic biliary atresia and normal-range serum gamma-glutamyltranspeptidase activity: A case report
Benno Kohlmaier1, Heidelis Tichy2, Jasmin Blatterer2
1Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics Medical University of Graz Graz Austria.
Insights
This study reports a rare case of biliary atresia with low gamma-glutamyltranspeptidase (GGT) levels, a finding typically associated with poorer outcomes. Further investigation is recommended for similar cases to understand GGT
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Genetic Medicine
Background:
- Biliary atresia (BA) is a severe neonatal liver disease.
- Elevated serum gamma-glutamyltranspeptidase (GGT) is a common biomarker in BA.
- Low GGT activity in BA is exceptional and linked to worse clinical outcomes.
Purpose of the Study:
- To describe a unique case of BA with normal-range GGT.
- To explore potential mechanisms and implications of low-GGT cholestasis in BA.
- To highlight the need for comprehensive investigations in such cases.
Main Methods:
- Case report of an infant with biliary atresia and low GGT.
- Clinical assessment and biomarker analysis.
- Genetic testing for known cholestasis-associated genes.
Main Results:
- The patient presented with biliary atresia and normal GGT levels.
- No pathogenic variants were identified in genes associated with poor prognosis or low-GGT cholestasis.
- The infant maintained stable disease with unremarkable biomarkers at 14 months.
Conclusions:
- Low GGT in biliary atresia warrants further investigation beyond standard genetic panels.
- Understanding the mechanisms of low-GGT cholestasis is crucial for predicting BA prognosis.
- Extended investigations, including genetic testing, may reveal coexistent disorders and advance knowledge of GGT's role in BA.
Abstract:
An infant with biliary atresia had normal-range ('low') serum gamma-glutamyltranspeptidase (GGT) activity, exceptional because GGT generally is elevated in biliary atresia. Mechanisms underlying low-GGT cholestasis in biliary atresia are not defined, but the phenomenon is associated with worse clinical outcome. Testing in our patient revealed no variants in genes mutated in several disorders also associated with poor prognosis and with low-GGT cholestasis; indeed, at age 14 months she has stable disease with unremarkable biomarker values. Nonetheless, we recommend extended investigations in such patients, including genetic testing, to detect coexistent disorders and to expand understanding of GGT in biliary atresia.
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