E Grimaud et al. Hepatology 2026; 84: 117-128. Serum bile acid levels predict the development of portal hypertension and high-risk esophageal varices following successful Kasai in biliary atresia
Methods: The authors examined the predictive value of serum bile acids (sBA) patients (n=57) with biliary atresia who underwent a successful Kasai Procedure (KP), defined as a total serum bilirubin level of ≤25 μmol/L within 6 months after KP.
Key findings:
- sBA thresholds of 56 and 30 μmol/L at a median time of 6 and 11 months after KP predicted HRV within 5 years after KP with a sensitivity of 100%.
- No patient with sBA <18 μmol/L (between 4-9 months after KP) developed portal hypertension (PH) at 3 and 5 years after Kasai, whereas sBA >41 μmol/L predicted PH with PPV of 91% and 97% at 3 and 5 years after KP, respectively
From editorial on pages 1-2: “Persistent elevation f=of sBA likely reflects ongoing intrahepatic cholestasis and bile-acid mediated hepatocellular and fibrogenic injury, even in the setting of ostensibly adequate biliary drainage.”
My take: This study is in agreement with others regarding the predictive value of sBA. It suggests the current definition of a successful KP needs modification to incorporate sBA. Those with good bilirubin parameters but with persistent elevation of sBA could be considered partially-successful KP.
Related blog posts:
- Prognostic Tool for Biliary Atresia after Kasai: Serum Bile Acids
- Precision Prediction of Biliary Atresia Survival
- New Era in Cholestatic Liver Diseases
- 30 -Year Outcomes with Biliary Atresia
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