Department of Pediatrics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Taipei, Taiwan.
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Eur J Pediatr. 2021 Aug;180(8):2539-2547. doi: 10.1007/s00431-021-04098-9. Epub 2021 May 8.
Biliary stricture is an important biliary complication after liver transplant in children. We aimed to investigate the utility of serum bile acid levels for prediction of biliary stricture in children after liver transplant. This study enrolled 60 children who underwent liver transplantation at a mean age of 2.04±0.30 years; serum bile acid levels were surveyed in a cross-sectional design. These patients were followed regularly at our institute, and the clinical data were collected prospectively. The major indication of liver transplant in this pediatric cohort was biliary atresia (78.33%). During the follow-up period (3.08±0.30 years), nine patients (15%) developed biliary stricture after the check of serum bile acid. A receiver operating characteristic curve analysis yielded a serum bile acid cutoff of >40 μM for the prediction of biliary stricture (P = 0.002). A serum bile acid level >40 is the most important predictor of a biliary stricture after liver transplant (odds ratio=65.65, P = 0.003) after adjusting for gender and GGT levels. The phenomenon remained on Cox's proportional hazard survival analysis (hazard ratio =15.42, P = 0.001). The mortality risk after liver transplant was significantly higher in subjects with serum bile acid levels >40 μM than in those with levels ≤40 μM (log-rank test, P = 0.004).Conclusion: Serum bile acid levels can be used for non-invasive screening and prediction of biliary stricture and mortality in children after liver transplantation. What is Known: • Biliary stricture is a major biliary complication after pediatric liver transplantation, and we showed the serum bile acid level significantly associates with biliary stricture. What is New: • In this study, we demonstrated the serum bile acid level may assist in the early detection of biliary stricture and mortality non-invasively.
胆道狭窄是儿童肝移植后的重要胆道并发症。我们旨在研究血清胆汁酸水平对预测儿童肝移植后胆道狭窄的作用。这项研究纳入了 60 名平均年龄为 2.04±0.30 岁的接受肝移植的儿童；采用横断面设计检测血清胆汁酸水平。这些患者在我们的研究所定期随访，前瞻性地收集临床数据。本儿科队列肝移植的主要指征是胆道闭锁（78.33%）。在随访期间（3.08±0.30 年），9 名（15%）患者在检查血清胆汁酸后出现胆道狭窄。受试者工作特征曲线分析得出，血清胆汁酸>40μM 是预测胆道狭窄的截断值（P=0.002）。在校正性别和 GGT 水平后，血清胆汁酸水平>40μM 是肝移植后胆道狭窄的最重要预测因素（优势比=65.65，P=0.003）。该现象在 Cox 比例风险生存分析中仍然存在（风险比=15.42，P=0.001）。与血清胆汁酸水平≤40μM 的患者相比，水平>40μM 的患者肝移植后死亡率显著更高（对数秩检验，P=0.004）。结论：血清胆汁酸水平可用于非侵入性筛查和预测儿童肝移植后胆道狭窄和死亡率。已知内容：• 胆道狭窄是儿童肝移植后的主要胆道并发症，我们表明血清胆汁酸水平与胆道狭窄显著相关。新内容：• 在这项研究中，我们表明血清胆汁酸水平可能有助于早期发现胆道狭窄和非侵入性死亡率。
