Predictors of outcome among children with biliary atresia: a single centre trial

This study aimed to investigate the predictive role of preoperative gamma-glutamyl transpeptidase (GGT) levels on the prognosis of neonatal biliary atresia (NBA) in patients who underwent the Kasai procedure.

A retrospective analysis was conducted of patients with NBA who underwent the Kasai procedure at our hospital from 2017 to 2021. Patients were categorized into high (GGT > 300 IU/L) and GGT inadequate (GGT ≤ 300 IU/L) groups based on preoperative GGT levels. The influence of GGT levels on NBA prognosis was evaluated by comparing clinical data, age at operation, jaundice normalization, and survival outcomes between the groups.

A total of 74 patients with NBA were included, with 59 in the high GGT group and 15 in the GGT inadequate group. Ages at the time of the Kasai procedure ranged from 31 to 106 days, with a median of 61 days; the average weight was 4.8 ± 1.1 kg. Two years post-procedure, 56 patients (75.7%) survived with their native liver (P < 0.0001). At 3 months post-procedure, alanine aminotransferase (ALT) levels were significantly higher in the GGT inadequate group compared to the high GGT group (3.5 times vs. 2.3 times the upper limit of normal, P = 0.0259). Significant differences in GGT levels persisted 1-month post-procedure (P = 0.0473). Jaundice clearance was significantly higher in the high GTT group (P = 0.0171) after 6 months. Multivariate logistic regression indicated a substantially higher mortality rate in the GGT inadequate group (P = 0.0452), with no significant age difference at operation (P = 0.8449). Preoperative GGT is a valuable predictor for NBA prognosis (area under the curve (AUC) 0.754, 95% confidence interval CI [0.640-0.847], P = 0.001, specificity 91.1%, and sensitivity 61.1%).

High preoperative GGT levels predict better prognosis in patients with NBA undergoing Kasai operation.