Risk factors for postoperative growth retardation in children with biliary atresia after kasai portoenterostomy: A
Xinyue Tan1, Guantong Li1, Xuming Liu1
1Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Insights
Children with biliary atresia (BA) who underwent Kasai portoenterostomy (KPE) and experienced growth retardation (GR) had higher early postoperative very low-density lipoprotein (VLDL) levels. Monitoring VLDL may aid in early nutritional assessment for these patients.
Area of Science:
- Pediatric Surgery
- Hepatology
- Growth and Development
Background:
- Biliary atresia (BA) is a severe neonatal liver disease requiring surgical intervention.
- Kasai portoenterostomy (KPE) is the primary surgical procedure for BA to restore bile flow.
- Postoperative growth retardation (GR) is a significant complication affecting long-term outcomes in BA patients.
Purpose of the Study:
- To evaluate growth and development in children with BA post-KPE.
- To identify risk factors associated with postoperative GR in BA patients.
- To explore the relationship between biochemical markers and GR.
Main Methods:
- A retrospective-observational study of 88 BA patients who underwent KPE.
- Growth assessment using Z-scores; GR defined as Z-scores <-2SD.
- Logistic regression with LASSO feature selection to identify GR predictors.
Main Results:
- The prevalence of GR was 15.9% in the cohort.
- Early postoperative very low-density lipoprotein (VLDL) levels were significantly associated with GR (OR = 3.769).
- Distinct postoperative metabolic profiles, including creatine kinase and albumin, were observed in the GR group.
Conclusions:
- Elevated early postoperative VLDL levels are a key indicator of GR in BA patients.
- VLDL may be linked to reduced muscle-related markers, suggesting altered metabolism.
- Early postoperative VLDL monitoring can help identify BA patients needing earlier nutritional support.
Objective:
This study aimed to evaluate the growth and development status of children with biliary atresia (BA) following Kasai portoenterostomy (KPE) and identify the risk factors associated with postoperative growth retardation (GR).
Methods:
A retrospective-observational study was conducted on 88 BA patients who underwent KPE at a single center between March 2016 and October 2024. Growth was assessed using Z-scores with GR defined as weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ) or BMI-for-age Z-Score (BAZ) < -2SD at final follow-up. Clinical and biochemical variables were compared between GR and non-GR groups. Logistic regression with LASSO feature selection was used to explore variables associated with GR.
Results:
The prevalence of GR was 15.9% (14/88) in the overall cohort and 17.7% (11/62) in native-liver survivors. GR was more common in children aged <2.5 years and >7.5 years. Lower weight at surgery, preoperative very low-density lipoprotein (VLDL), creatinine (Cr) and Prealbumin (PA), as well as early postoperative VLDL and Lactate dehydrogenase (LDH) levels were associated with GR. Early postoperative higher VLDL levels were the sole variable retained in the exploratory LASSO model (OR = 3.769, 95% CI: 1.608-11.199, p < 0.05), with an optimal cut-off value of 0.45 mmol/L. Dynamic biochemical analysis revealed distinct metabolic profiles in the GR group, including creatine kinase (CK), uric acid (UA) and albumin (ALB) postoperatively.
Conclusion:
Early postoperative higher VLDL levels were associated with GR in BA patients and with reduced muscle-related markers, suggesting a distinct metabolic profile. Monitoring early postoperative VLDL may help identify children who could benefit from earlier nutritional assessment.