Title: Serum FGF19 combined with GGT and other biomarkers predicted native liver survival following Kasai portoenterostomy in early biliary atresia
Source: Journal of Gastroenterology 2025, 60 (6): 783-793
Date of publication: June 2025
Publication type: Cohort study
Abstract: Background: Accurately predicting the prognosis of biliary atresia (BA) prior to Kasai portoenterostomy (KPE) remains a challenge. The identification of the specific BA population that may benefit from primary liver transplantation (pLT) instead of KPE remains elusive.
Methods: A total of 196 BA patients and 31 age-matched non-BA cholestasis patients were recruited. BA patients were divided into training (February 2018-February 2019) and validation (March 2019-December 2021) cohorts. C-index was applied to evaluate the utility of indicators and models.
Results: Serum fibroblast growth factor 19 (FGF19) was elevated in BA patients [95.67 (58.97-140.6) vs. 58.73 (43.59-85.35) pg/ml, P = 0.0003]. Constructed with FGF19, GGT, DBIL, and ALB, nomogram A demonstrated optimal C-index in training (0.767 ± 0.039) and validation (0.721 ± 0.062) cohorts with ideal consistency in predicting 1-year NLS after KPE as well as potential clinically utility in BA patients with an age at KPE ≤ 60 days. Leveraging the risk score (RS) developed with nomogram A, our findings revealed a notable decrease in 2-year NLS after KPE among BA patients with a preoperative RS > 1.36, and the patients with a preoperative RS > 2.6 appear to be potential candidates for pLT [2-year NLS after KPE: 0% (training cohort), 21.4% (validation cohort); specificity = 100% and sensitivity = 22.2%].
Conclusions: Nomogram A demonstrated significant efficacy in preoperatively predicting NLS in early BA. BA patients (age at KPE ≤ 60 days) with a RS > 2.6 may potentially benefit from pLT.
