Serum Adiponectin and Fibroscan as Non‑invasive Post‑operative Prognostic Markers for Biliary Atresia

Majority of patients with biliary atresia (BA), including those who undergo Kasai hepatico‑portoenterostomy, develop cirrhosis, hepatic fibrosis and eventually progress to end‑stage liver disease. Therefore, early assessment of hepatic status and fibrosis is essential. The study objective was to estimate serum adiponectin, liver function tests and to associate them with liver stiffness scores in post‑operative BA patients.

A total of 30children (20 post‑Kasai BA cases and 10 healthy controls) were enrolled in this prospective case-control study. Serum adiponectin was measured by enzyme‑linked immunosorbent assay, and hepatic fibrosis by transient elastography (TE) (FibroScan). The BA patients were further divided into two groups: a jaundiced group (total bilirubin [TB] ≥2 mg/dl) and a non‑jaundiced group (TB <2 mg/dl). Comparison of biomarkers was also done in these subgroups and controls by Kruskal-Wallis test.

Adiponectin levels were significantly higher in BA cases than controls (median and interquartile range: 27.4 and 14.7 vs. 3.65 and 3.45 mg/ml, P = 0.001). Liver stiffness values in BA patients were also markedly more than controls (9.95 and 5.45 vs. 4.60 and 4.48 kPa, P = 0.002). Furthermore, serum adiponectin and liver stiffness scores were considerably higher in cases with jaundice in comparison to non‑jaundiced cases (P = 0.013 and 0.001, respectively). Serum adiponectin revealed a positive correlation with TB (r = 0.81, P < 0.00001) and FibroScan status (r = 0.96, P < 0.00001).

The estimation of adiponectin levels and TE can be considered to be novel non‑invasive methods to monitor post‑Kasai hepatic status in BA patients.