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

Video Published 2024-02-26 Updated 2026-08-01

Timestops (17)

OK. So, we are um having the last presentation of this heat with Doctor Yingying Yang from PAPS, the Pacific Association…

My topic is clinical characteristics and prognosis of biliar…

My topic is clinical characteristics and prognosis of biliary atria with low serum MMP 7 levels. Breatresia is a severe …

Recently, it has been reported that MMP 7 can help precisely discriminate BA from other cholecystic diseases at a cutoff…

Thus, we empathize that this might be a new clinical subtype FBA, and we wonder how does low MMP7 correlate with the pro…

They were divided into low MMP 7 group and high MMP 7 group …

They were divided into low MMP 7 group and high MMP 7 group based on the preoperative MMP 7 levels of 2025. For each pat…

The median 7MMP7 level for low MMP 7 group was 20

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…

For the three-month strongest clearance rate

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…

A total of 90 patients in the low MMP 7 group and 112 patien…

A total of 90 patients in the low MMP 7 group and 112 patients in the high MMP 7 group died or underwent liver transplan…

So taken together

So taken together, around 10% of VA patients have low 7 MMP 7 levels. On a preoperative gamma GT and direct bilobin were…

So more subjects and a long-term follow-up are warranted to …

So more subjects and a long-term follow-up are warranted to determine whether this could be listed as a new clinical sub…

One of our limitations in this study was the period of follo…

One of our limitations in this study was the period of follow-up maybe not long enough for some patients, ranging from 3…

However, the dynamic analysis of MMP 7 levels postoperatively will be meaningful in further understanding the mechanism.…

So here we have Doctor Yang.

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…

So, it's very easy.

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 …

And do you think that we can um eventually target this MMP 7…

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…

And I think, uh, nowadays it's CSI procedure is still the first line treatment for bilireatresia, but as we can see, the…

So someday if we are definitely uh clear about their mechani…

So someday if we are definitely uh clear about their mechanism of MMP 7 in bilireresia, maybe someday, the patients with…

Topic Overview

A research presentation on biliary atresia (BA) patients with low serum matrix metalloproteinase-7 (MMP-7) levels, examining whether this represents a distinct clinical subtype. The study of 329 BA patients who underwent Kasai procedure found that approximately 10% had low MMP-7 (<20-25 ng/mL), and these patients demonstrated significantly lower jaundice clearance rates (32% at 6 months vs 55% in high MMP-7 group) and worse native liver survival (30% at 1 year vs 53%). The low MMP-7 group also had lower preoperative gamma-GT and direct bilirubin levels, and more severe fibrosis stages, suggesting this may represent a more severe disease phenotype that could potentially warrant earlier consideration of liver transplantation.

Key Takeaways

~10% of BA patients have low preop MMP-7 (<25 ng/mL), correlating with worse fibrosis and lower gamma-GT levels. (2:16)
Low MMP-7 BA patients show 32% 6-month jaundice clearance vs 55% in high MMP-7 group after Kasai procedure. (2:50)
1-year native liver survival is 30% in low MMP-7 group vs 53% in high MMP-7 group, suggesting distinct phenotype. (3:16)
Low preop MMP-7 may identify BA patients who warrant earlier liver transplant consideration over Kasai alone. (3:50)

Inside this episode

Kai, the Library's AI content creator, listened to this episode and mapped who's speaking, the chapters, key claims, and cases. Every item links to the exact moment in the recording.

AI-enriched

Who's speaking

Speaker 1 — host
Zhang Jing — guest

Chapters

0:00Introduction and Background — Introduction of presenter Zhang Jing from Children's Hospital of Finan University. Background on biliary atresia, MMP-7 as a diagnostic marker with cutoff around 20 ng/mL, and the observation that 5-10% of BA patients have false-negative low MMP-7 levels.
1:24Study Methods and Results — Study design reviewing 329 BA patients divided into low and high MMP-7 groups. Results showing significant differences in preoperative markers, jaundice clearance rates at 3 and 6 months, and one-year native liver survival rates between groups.
3:29Discussion and Limitations — Summary of findings suggesting low MMP-7 may represent a new clinical subtype with worse outcomes. Discussion of study limitations including follow-up duration, patient exclusions, and lack of postoperative MMP-7 measurements.
5:04Q&A Session — Discussion of MMP-7 measurement methodology (ELISA-based, costs approximately 1000 RMB in China), and potential future clinical implications including possible direct referral to liver transplantation for low MMP-7 patients.

Key claims

0:42Biliary atresia is a severe liver disease characterized by fibro-inflammatory destruction of bile ducts — Zhang Jing
0:48MMP-7 can help precisely discriminate BA from other cholestatic diseases at a cutoff value of around 20 ng/mL — Zhang Jing
1:005 to 10% of BA patients have false negative MMP-7 levels — Zhang Jing
1:24329 BA patients who underwent Kasai procedure from 2020 to 2022 were reviewed — Zhang Jing
1:34Patients were divided into low and high MMP-7 groups based on preoperative MMP-7 levels of 20-25 ng/mL — Zhang Jing
2:03The median MMP-7 level for low MMP-7 group was 20.19 ng/mL compared with 66.55 ng/mL for the high MMP-7 group — Zhang Jing
2:16Preoperative gamma-GT and direct bilirubin in the low MMP-7 group were significantly lower than those in the high MMP-7 group — Zhang Jing
2:26Fibrosis stages were significantly different between the two groups — Zhang Jing
2:34Three-month jaundice clearance rate was 46.91% for the high MMP-7 group and 29.73% for the low MMP-7 group — Zhang Jing
2:50Six-month jaundice clearance rate was 54.51% for the high MMP-7 group and 32.14% for the low MMP-7 group — Zhang Jing
3:0390 patients in the low MMP-7 group and 112 patients in the high MMP-7 group died or underwent liver transplantation by latest follow-up — Zhang Jing
3:16One-year native liver survival rate was 29.63% for the low MMP-7 group and 53.02% for the high MMP-7 group — Zhang Jing
3:29Around 10% of BA patients have low MMP-7 levels — Zhang Jing
3:41Low gamma-GT levels correlated with more severe liver injury and poor outcomes in previous study — Zhang Jing
3:50BA patients in the low MMP-7 group had a lower jaundice clearance rate and native liver survival rate — Zhang Jing
4:11Follow-up period ranged from 3 months to 3 years — Zhang Jing
4:11Some patients lost follow-up within 3 months and were excluded from final analysis — Zhang Jing
4:30Patients did not take MMP-7 measurements post-Kasai procedure — Zhang Jing
5:26MMP-7 measurement is based on ELISA method — Zhang Jing
5:44MMP-7 testing costs about 1000 RMB per measurement in China — Zhang Jing
5:36MMP-7 testing is not very popular in every hospital in China, just in some institutions — Zhang Jing
6:14Kasai procedure is still the first line treatment for biliary atresia — Zhang Jing
6:14Some BA patients could not achieve jaundice clearance and could not live long with their native liver — Zhang Jing
6:34Patients with low MMP-7 might someday go directly for liver transplantation if the mechanism is clearly understood — Zhang Jing

Open questions

Whether low MMP-7 BA patients should be listed as a new clinical subtype
What is the mechanism of MMP-7 in biliary atresia pathophysiology
Whether patients with low MMP-7 should be considered for direct liver transplantation rather than Kasai procedure
What are the dynamic changes in MMP-7 levels postoperatively and their prognostic significance
Will MMP-7 testing become more widely available and cost-effective

This episode was analyzed and enriched by Kai, the Library's AI content creator. Every item links to the moment it comes from — click a timestamp to listen in context.

Low MMP-7 in Biliary Atresia: Recognizing a High-Risk Subgroup

The episode's teaching points arranged as a structured lesson, building from the basics up to the finer points. Written by Kai from the episode transcript and reviewed before publishing.

For trainees · Teaching arc · AI-written, human-reviewed

The Diagnostic Paradox of MMP-7

MMP-7 has emerged as a reliable biomarker for distinguishing biliary atresia from other cholestatic diseases, with a cutoff around 20 ng/mL providing precise discrimination 0:48. But 5 to 10% of confirmed BA patients fall below this threshold — false negatives by the diagnostic standard 1:00. The critical insight is recognizing these aren't simply measurement errors. They represent approximately 10% of the BA population 3:29, and their outcomes diverge sharply from the majority.

What Low MMP-7 Predicts

A retrospective analysis of 329 BA patients who underwent Kasai procedure divided patients at the 20-25 ng/mL threshold 1:24 1:34. The low MMP-7 group (median 20.19 ng/mL) differed from the high group (median 66.55 ng/mL) in more than just the biomarker 2:03. Their preoperative gamma-GT and direct bilirubin were significantly lower 2:16, and their liver fibrosis stages were more severe 2:26. This biochemical profile — low MMP-7, low gamma-GT, advanced fibrosis — defines the phenotype.

The prognostic separation appears early and persists. At three months post-Kasai, jaundice clearance was achieved in 29.73% of low MMP-7 patients versus 46.91% of high MMP-7 patients 2:34. By six months, the gap widened: 32.14% versus 54.51% 2:50. One-year native liver survival told the same story: 29.63% for low MMP-7 patients, 53.02% for high MMP-7 patients 3:16. These aren't marginal differences — they represent a near-doubling of failure risk.

The Low Gamma-GT Connection

The correlation between low MMP-7 and low gamma-GT matters because prior work established that low gamma-GT BA patients have more severe liver injury and worse outcomes 3:41. The current findings confirm this pattern extends to MMP-7 3:50. When you encounter a BA patient with both markers suppressed, you're looking at someone whose disease has already progressed further than the biochemistry initially suggests. The low values aren't reassuring — they're ominous.

Clinical Implications and Limitations

The Kasai procedure remains first-line treatment for biliary atresia 6:14, but some patients never clear their jaundice and cannot sustain native liver survival 6:14. If low preoperative MMP-7 reliably identifies this group, it could eventually inform earlier transplant planning 6:34. That decision framework doesn't exist yet — the mechanism linking low MMP-7 to poor outcomes isn't fully understood, and the evidence base needs expansion.

The study's limitations constrain immediate application. Follow-up ranged from three months to three years 4:11, and patients lost within three months were excluded 4:11 — a design that may have removed some of the sickest patients from analysis. No postoperative MMP-7 measurements were obtained 4:30, so whether the biomarker tracks with disease progression or response to surgery remains unknown. The test itself, performed by ELISA 5:26, costs approximately 1000 RMB per measurement in China 5:44 and isn't widely available 5:36.

The Emerging Framework

What you're learning to recognize is a potential clinical subtype: BA patients whose low MMP-7 signals not a false negative but a distinct, more aggressive disease course. When preoperative labs show MMP-7 below 25 ng/mL alongside low gamma-GT, expect worse clearance rates, lower native liver survival, and earlier need for transplant evaluation. The Kasai procedure is still indicated, but your counseling and follow-up intensity should reflect the higher risk. The discussant emphasized that more subjects and longer follow-up are needed to formally establish this as a BA subtype 3:50, but the pattern is consistent enough to inform your clinical judgment now.

Takeaways from this story

Low MMP-7 (<25 ng/mL) identifies ~10% of BA patients with significantly worse outcomes: half the 1-year native liver survival of high MMP-7 patients.
Low MMP-7 correlates with low gamma-GT and advanced fibrosis — a biochemical profile signaling more severe disease, not reassurance.
Jaundice clearance rates diverge early: only 30% of low MMP-7 patients clear by 3 months versus high MMP-7 patients.
MMP-7 testing (ELISA-based, ~1000 RMB) isn't widely available yet, but may eventually guide earlier transplant evaluation in high-risk patients.

Keywords

biliary atresia cholestatic diseases liver injury fibrosis Kasai procedure liver transplantation ELISA Children's Hospital of Finan University Pacific Association of Pediatric Surgeons

Hashtags

#BiliaryAtresia #MMP7 #PediatricSurgery #LiverTransplant #ClinicalResearch #Prognosis #Jaundice #LiverHealth #Fibrosis #KassaiProcedure #BiochemicalMarkers #LiverDisease #PediatricHealth #MedicalEducation #SurgicalOutcomes #Healthcare #ChildrensHealth #ClinicalTrials #Hepatology #LiverSurvival #PrognosticBiomarker

Transcript

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.

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