Serum predictors of native liver survival post-Kasai: Systematic review and meta-analysis

After hepatoportoenterostomy (HPE), a minority of biliary atresia (BA) patients reach adolescence without liver transplantation. Several serum markers have been suggested to better predict post-HPE outcomes in BA patients. We aimed to identify serum predictors of native liver survival (NLS) in post-HPE BA patients.

We searched PubMed, MEDLINE, SCOPUS, and EMBASE databases to identify publications from 1946 through December 2023. Studies included reported serum values as prognostic factors for BA after HPE, specifically total bilirubin (TB), alanine transaminase (ALT), gamma-glutamyl transferase (GGT), matrix metalloproteinase 7 (MMP-7), and total bile acids (TBA). We defined nonfunctioning HPE as persistent jaundice, cirrhosis, LT, or death. We calculated pooled serum variables, including hazard and odds ratios, for NLS using inverse variance weighting.

Thirty studies were included in the meta-analysis including a total of 4399 BA patients, 2073 and 1793 had successful versus nonfunctioning HPE, respectively. The mean HPE age for the successful group was significantly less (63.3 vs. 69.5 days, p < 0.001). TB was significantly elevated in the nonfunctioning group (p < 0.001). Pooled ALT and GGT were significantly lower in the successful group 1-3 months and >5 years after HPE (p < 0.001). The successful group had significantly lower serum TBA (27.55 vs. 69 μmol/L, p < 0.001) > 5 years after HPE.

Established serum values ALT, GGT, and TB are useful for prognostic assessment post-HPE. MMP-7 and TBA require additional evaluation to determine their prognostic relevance for NLS in BA.