Correlation of Transient Elastography and Progression of Cirrhosis in Longterm Survivors of Biliary Atresia

Objective: This study aimed to use transient elastography (TE) to evaluate the correlation between liver stiffness measure (LSM) and functional status of native liver in longterm follow-up of pediatric patients with biliary atresia (BA). Methods: Twenty cases of BA who had undergone hepatic portoenterostomy and had good initial outcome (total bilirubin < 2 mg/dL) were enrolled for a transient elastography. The LSMs derived from the study were analyzed with clinical and radiological parameters and endoscopic findings of esophageal varices. Results: The median age at enrollment of the 20 cases was 8.4 years. Of the 20 cases, 15 were diagnosed as cirrhosis by ultrasonography and 9 had esophageal varices detected by an endoscopy. Parameters that were significantly associated with LSM were history of cholangitis, splenomegaly, cirrhosis and esophageal varices. Significantly higher LSM was found to be correlated with hyperbilirubinemia, transaminitis, alkaline phosphatasemia, thrombocytopenia and prolonged INR. On linear regression, LSM was significantly correlated with pediatric end-stage liver disease score at the r2 of 0.32 and correlated with the aspartate transaminase to platelet ratio index at the r2 of 0.70. The area under the receiver operating characteristic curve that reflected the performance of LSM in predicting esophageal varices was 0.97. At the cut-off value of 10.2 kPa, the sensitivity and specificity of LSM in predicting esophageal varices were 100% and 72.7%, respectively. Conclusion: TE can be useful as a non-invasive, point-of-care evaluation of liver fibrosis in long term follow-up of BA. A high LSM indicates surveillance for esophageal varices in these patients