Jingying Jiang, MD - Best of the Best in Pediatric Surgery 2024

OK. So, we are um having the last presentation of this heat with Doctor Yingying Yang from PAPS, the Pacific Association of Pediatric Surgeons, with um clinical, clinical characteristics and prognosis of biliary attricia with low serum matrix, metaloproteinase, 7 levels. So, let's see it. Hello, everyone. I'm Zhang Jing from Children's Hospital of Finan University. My topic is clinical characteristics and prognosis of biliary atria with low serum MMP 7 levels. Breatresia is a severe liver disease characterized by fibro inflammatory destruction of bi ducts. Recently, it has been reported that MMP 7 can help precisely discriminate BA from other cholecystic diseases at a cutoff value of around 20. However, there were Still 5 to 10% of patients with force negative MMP7 whose characteristics and prognosis remain unknown. Thus, we empathize that this might be a new clinical subtype FBA, and we wonder how does low MMP7 correlate with the prognosis. So, we reviewed 329B patients who underwent Kassite procedure from 2020 to 2022. They were divided into low MMP 7 group and high MMP 7 group based on the preoperative MMP 7 levels of 2025. For each patient, characteristics were reviewed on their demographics, clinical manifestations, and histological features, and the jaundice clearance rate and the liver survival, native liver survival rate were used to evaluate the prognosis. The median 7MMP7 level for low MMP 7 group was 20.19 compared with 66.55 for the high MMP 7 group. Preoperative gamma GT and the direct bilobin in the low MMP 7 group were significantly lower than those in the high MMP 7 group. Additionally, fibrosis stages were significantly different between these two groups. For the three-month strongest clearance rate, it was 46.91% for the high MMP seven group, and it was only 29.73% for the low MMP seven group. And for the six month drownest clearance rate, it was 54.51% for the high MMP seven group and 32.14% for the low MMP seven group. A total of 90 patients in the low MMP 7 group and 112 patients in the high MMP 7 group died or underwent liver transplantation by the latest follow-up. The one-year native liver survival rate was 29.63 for the low MMP7 group and 53.02% for the high MMP 7 group. So taken together, around 10% of VA patients have low 7 MMP 7 levels. On a preoperative gamma GT and direct bilobin were significantly lower. Our previous study suggested. Low gamma GT levels correlated with more severe liver injury and poor outcomes. Consistently, BA patients in the low MMP 7 group also had a lower jaundice clearance rate than the native liver survival rate. So more subjects and a long-term follow-up are warranted to determine whether this could be listed as a new clinical subtype of BA. One of our limitations in this study was the period of follow-up maybe not long enough for some patients, ranging from 3 months to 3 years, and some patients lost follow up within 3 months and were excluded from final analysis which may Introduceed buyers to the results. Finally, the patients did not take MMP 7 measurements post Kasa procedure. However, the dynamic analysis of MMP 7 levels postoperatively will be meaningful in further understanding the mechanism. We are continuously following up and correcting such cases, hoping to give more evidence on the correlation between low MMP 7 and the long-term prognosis of BA. That's all. Thank you so much. Awesome. So here we have Doctor Yang. Thank you for this presentation. Um, and I wanted to ask, like, how do we assess this MMP 7 and um how much will it cost to add it to our normal panel on biliary attrition? Uh, OK. So, the MMP 7 measurement is based on the 7, and, uh, it is based on the method of Eliza. So, it's very easy. And uh now in China, it's not very popular in every hospital, um just in some institutions. So it's cost about uh I think 1000 RMB for each patient, uh, each measurement. Uh, so, but, uh, if, if it become, it become popular someday, it will be cheaper, yes. Awesome. And do you think that we can um eventually target this MMP 7 or change our management if our patient has a low MMP 7? Uh, yes. And I think, uh, nowadays it's CSI procedure is still the first line treatment for bilireatresia, but as we can see, there's some patients, um, could not achieve their jaundice clearance and their um they couldn't live long for uh with their native liver. So someday if we are definitely uh clear about their mechanism of MMP 7 in bilireresia, maybe someday, the patients with low MMP 7 can go directly for liver transplantation. Awesome. That's great. Well, thank you. Uh, I think that's where all the questions for now.