Related Experiment Videos
Hepatic artery resistance index can predict early death in children with biliary atresia
1Institute of Gastroenterology and Liver Disease, Tel-Aviv University Medical School, Assaf Harofeh Medical Center, Zerifin, Israel.
Insights
Ultrasonography Doppler
Area of Science:
- Pediatric Hepatology
- Diagnostic Imaging
- Transplant Surgery
Background:
- Biliary atresia is a severe neonatal liver disease.
- Early detection and management are crucial for improving outcomes.
- Hepatic artery resistance index (HARI) is a potential prognostic marker.
Purpose of the Study:
- To evaluate the prognostic value of HARI in children with biliary atresia.
- To identify children with biliary atresia at high risk of mortality.
- To guide timely liver transplantation decisions.
Main Methods:
- Prospective data collection on clinical, biochemical, and ultrasonographic parameters.
- Comparison of patients with HARI >= 1.0 (Group A) versus HARI < 1.0 (Group B).
- Analysis of mortality, liver function tests, and transplantation rates.
Main Results:
- Group A patients exhibited significantly poorer liver function tests.
- Group A showed a 2-year survival rate of 52% compared to 94% in Group B.
- All Group A patients either died or required transplantation, with higher mortality post-transplant.
Conclusions:
- HARI >= 1.0 identifies biliary atresia patients with a very high risk of early mortality.
- Regular ultrasonography Doppler screening is recommended for early detection of high-risk patients.
- Prompt transplantation evaluation and priority upgrading are essential for these high-risk children.
Abstract:
Hepatic artery resistance index has been measured by ultrasonography Doppler and has been found to predict rapid deterioration and death in children with biliary atresia. Clinical, biochemical, ultrasonographic, and outcome data were collected prospectively and retrieved on 32 patients with resistance index of > or = 1.0 (group A). These were compared with the same data for 32 age- and sex-matched patients with biliary atresia and a resistance index of < 1.0 (group B). Group A was found to have significantly worse liver function tests than group B. In group A, all patients died (n = 11) or underwent transplantation (n = 21; of whom 4 died) compared with only 2 patients who died in group B and 4 patients who underwent transplantation without fatality. Survival at 2 years was 52% in group A v 94% in group B. It is suggested that regular ultrasonography Doppler examination in patients with biliary atresia can detect a group with a resistance index of > 1.0 who have a very high risk of early mortality. Such patients require early evaluation and listing for transplantation. Those listed for liver transplantation on other grounds require ultrasonography examinations every 2 to 3 months with immediate upgrading of the priority of those patients found to have a resistance index of > or = 1.0.