Factors predicting the need for liver transplantation in biliary atresia patients after 18 years of age
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In brief
In brief
This retrospective study identifies prognostic markers predicting liver transplantation need in biliary atresia patients reaching adulthood with native livers. Comparing 34 native liver survivors to 14 requiring transplantation, APRI score demonstrated superior predictive value over MELD, ALBI, and BALF scores at age 18.
- APRI score at age 18 is the most useful predictor of future liver transplant need in biliary atresia patients (AUC 0.91).
- MELD scores at 18 years did not significantly differ between native liver survivors and those requiring later transplantation.
- APRI, ALBI, and BALF scores at age 18 were significantly elevated in patients who subsequently required liver transplantation.
- Adult BA patients face limited transplant options due to donor scarcity, making prognostic markers for transplant need critical.
- Age at Kasai procedure and BA type did not predict need for transplantation after 18 years in native liver survivors.
Written by the GCMD Library team from the article.
Abstract
Purpose
We aimed to identify factors predicting the need for future liver transplantation (LT) at 18 years of age in patients with biliary atresia (BA).
Methods
BA patients with native liver survival at > 18 years of age were retrospectively reviewed. The clinical characteristics, outcomes, hepatobiliary function, and liver fibrosis markers of native liver survivors (NLS group) were compared with patients who subsequently underwent LT (LT group).
Results
The study population included 48 patients (NLS, n = 34; LT, n = 14). The male-to-female ratio, age at Kasai procedure, and type of BA in the two groups did not differ to a statistically significant extent. There was no significant difference in the MELD scores between the groups at 18 years of age. The aspartate aminotransferase-to-platelet ratio index (APRI), albumin-bilirubin (ALBI), and BA liver fibrosis (BALF) scores at 18 years of age were significantly higher in the LT group. The AUCs for APRI, ALBI, and BALF were 0.91, 0.79, and 0.85, respectively.
Conclusion
Adult BA patients have limited options for LT owing to the lack of donor candidates and the low prevalence of deceased donors. The elucidation of prognostic factors for LT in adulthood is important. APRI was the most useful marker in this study.