Serum FGF19 combined with GGT and other biomarkers predicted native liver survival following Kasai portoenterostomy in early biliary atresia.

BACKGROUND

Accurately predicting the prognosis of biliary atresia (BA) prior to Kasai portoenterostomy (KPE) remains a challenge. The identification of the specific BA population that may benefit from primary liver transplantation (pLT) instead of KPE remains elusive.

METHODS

A total of 196 BA patients and 31 age-matched non-BA cholestasis patients were recruited. BA patients were divided into training (February 2018-February 2019) and validation (March 2019-December 2021) cohorts. C-index was applied to evaluate the utility of indicators and models.

RESULTS

Serum fibroblast growth factor 19 (FGF19) was elevated in BA patients [95.67 (58.97-140.6) vs. 58.73 (43.59-85.35) pg/ml, P = 0.0003]. Constructed with FGF19, GGT, DBIL, and ALB, nomogram A demonstrated optimal C-index in training (0.767 ± 0.039) and validation (0.721 ± 0.062) cohorts with ideal consistency in predicting 1-year NLS after KPE as well as potential clinically utility in BA patients with an age at KPE ≤ 60 days. Leveraging the risk score (RS) developed with nomogram A, our findings revealed a notable decrease in 2-year NLS after KPE among BA patients with a preoperative RS > 1.36, and the patients with a preoperative RS > 2.6 appear to be potential candidates for pLT [2-year NLS after KPE: 0% (training cohort), 21.4% (validation cohort); specificity = 100% and sensitivity = 22.2%].

CONCLUSIONS

Nomogram A demonstrated significant efficacy in preoperatively predicting NLS in early BA. BA patients (age at KPE ≤ 60 days) with a RS > 2.6 may potentially benefit from pLT.