title: Clinical benefit of liver stiffness measurement at 3 months after Kasai hepatoportoenterostomy to predict the liver related events in biliary atresia.
abstract: BACKGROUND
  The progression of hepatic fibrosis may result in decompensated hepatic failure with cirrhosis, liver related events (LRE) such as ascites, variceal bleeding, and death after successful and timely Kasai hepatoportoenterostomy (HPE) in biliary atresia. The aim of this study is to suggest clinical benefit of the liver stiffness measurement (LSM) using transient elastography at 3 months after the Kasai operation to predict LRE.
  
  
  METHODS
  Between January 2007 and December 2011, 69 eligible biliary atresia patients who underwent Kasai HPE and performed transient elastography before and 3 months after HPE were included. The occurrences of LRE were analyzed for all patients. All patients were divided into 2 groups (with and without LRE) for comparison. Multivariate analysis was used to detect the independent risk factors of LRE. The area under the receiver operation characteristics curve (AUROC) was used to establish the LSM optimal cutoff value of 3 months after Kasai operation in predicting LRE.
  
  
  RESULTS
  LSM value, aminotransferase, albumin, bilirubin, and PT-INR significantly differed among the two groups. Multivariate analysis demonstrated LSM value as the most powerful independent factor of the development of LRE. The cut-off value of 19.9 kPa was calculated to be optimal for predicting LRE development with total sensitivity and specificity of 1.804. AUROC resulted in 0.943, with sensitivity of 85.3% and specificity of 95.2%.
  
  
  CONCLUSIONS
  The LSM value of 3 months after Kasai HPE can be a useful predictor of LRE development.
authors.affiliation: Department of Pediatrics, Yonsei University College of Medicine, Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Seoul, Korea.
authors.forename: Seung Min
authors.initials: SM
authors.lastname: Hahn
authors.forename: Seung
authors.initials: S
authors.lastname: Kim
authors.forename: Kook In
authors.initials: KI
authors.lastname: Park
authors.forename: Seok Joo
authors.initials: SJ
authors.lastname: Han
authors.forename: Hong
authors.initials: H
authors.lastname: Koh
mesh_terms: D001656:Biliary Atresia / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques / Q000379:methods / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008111:Liver Function Tests; D008297:Male; D011379:Prognosis; D012372:ROC Curve; D012016:Reference Values; D015203:Reproducibility of Results; D012307:Risk Factors