Correlation Analysis Between Preoperative Liver Ultrasound Elastography and Postoperative Jaundice Clearance After Kasai Surgery for Biliary Atresia.

BACKGROUND

Biliary atresia (BA) is a rare but life-threatening neonatal cholestatic disease, characterized by obliteration of the intra-and extrahepatic bile ducts, leading to persistent jaundice, cirrhosis, and liver failure if untreated. Liver fibrosis is the most important feature of BA. In recent years, ultrasound elastography, particularly liver stiffness measurement (LSM), has acted as a noninvasive alternative for evaluating liver fibrosis in BA.

OBJECTIVE

To explore the correlation between preoperative LSM and postoperative jaundice clearance in BA patients undergoing Kasai portoenterostomy (KPE), and to provide a reference for predicting early surgical outcomes.

METHODS

Clinical data of BA patients who underwent KPE at were retrospectively analyzed. Preoperative ultrasound and blood tests were performed before surgery, and liver fibrosis was scored using the Metavir system based on liver biopsy tissues. Patients were divided into jaundice clearance and non-clearance groups based on total bilirubin (TB) levels three months postoperatively. Differences in demographics, ultrasound parameters, blood biomarkers, and liver fibrosis stages were analyzed. The optimal LSM cutoff value was determined using ROC analysis.

RESULTS

Among 121 BA patients, 78 achieved jaundice clearance. Univariate analysis showed that higher LSM, elevated AST, TB, direct bilirubin and APRI were significantly associated with non-clearance. Logistic regression identified LSM as an independent predictor. The optimal LSM cutoff was 11.74 kPa. Patients with LSM ≥11.74 kPa had worse preoperative indicators and poorer postoperative recovery.

CONCLUSION

Higher preoperative LSM predicts poorer jaundice clearance and delayed recovery post KPE. LSM may serve as a valuable preoperative predictor for early surgical outcomes.