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Cholangitis, high bilirubin predict future need for liver transplant in adolescents with biliary atresia

17 Jun 2019

Cholangitis in adolescence and bilirubin levels 21 µmol/L at 16 years of age predict the future need for liver transplant (LT) in young people with biliary atresia, a new study has found.

Researchers performed a single-centre retrospective analysis of 89 patients who had undergone Kasai portoenterostomy and who had demonstrated native liver survival (NLS) until 16 years of age. Of the participants, 67 had NLS >16 years of age (group 1; median age, 16.0 years), while 22 required LT (group 2; median age, 16.1 years).

Kaplan-Meier analysis showed that 75 percent of the patients survived a mean of 6.9 years with their native liver. At 5 and 10 years after their respective 16th birthdays around 80 percent and 60 percent still had their native livers.

Both groups showed significant differences across most laboratory and radiological parameters tested. Bilirubin, for instance, was significantly higher in group 2 (38.5 vs 12 µmol/L; p<0.001), while the opposite was true for albumin (45 vs 37.5 g/L; p<0.001). Sodium was the only parameter comparable between groups (141 vs 140 mmol/L; p=0.117).

In comparison, at least one episode of cholangitis was reported significantly more frequently in group 2 vs 1 over the follow-up period (31.8 percent vs 3.03 percent; p=0.001).

Univariate Cox proportional hazard analysis showed that cholangitis increased the risk of LT >16 years by more than fourfold (hazard ratio [HR], 4.897, 95 percent CI, 1.973–12.158; p=0.001). The same was true for increased serum bilirubin (HR, 1.04, 1.026–1.054; p<0.001), while creatinine shared a significantly inverse correlation with LT >16 years (HR, 0.937, 0.901–0.974; p=0.001).

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