Normal Gamma Glutamyl Transferase Levels at Presentation Predict Poor Outcome in Biliary Atresia

Abstract

Objectives: Gamma-glutamyl transferase levels (GGT) are typically elevated in biliary atresia (BA), but normal GGT levels have been observed. This cohort of “normal GGT” BA has neither been described nor has the prognostic value of GGT level on outcomes in BA. We aimed to describe outcomes of a single-centre Australian cohort of infants with BA and assess the impact of GGT level at presentation on outcomes in BA. Methods: Infants diagnosed with BA between 1991 and 2017 were retrospectively analysed. Outcomes were defined as survival with native liver, liver transplantation (LT), and death. Patients were categorized into normal (<200I U/L) or high GGT groups based on a mean of 3 consecutive GGT values done before Kasai portoenterostomy (KPE). Baseline parameters, age at surgery, clearance of jaundice (COJ), and outcomes were compared between the 2 groups. Results: One hundred thirteen infants underwent KPE at median 61 (30–149) days. At a median follow-up of 14.2 (0.9–26.3) years, 35% (39/113) patients were surviving with native liver, 55% (62/113) underwent LT and 11% (12/113) died pretransplant. 12.3% (14/113) patients had normal GGT. Age at KPE and time to COJ were similar between normal and high GGT groups. Normal GGT group had shorter time from KPE to LT (11 vs 18 months, P = 0.02), underwent LT at a younger age (14 vs 20 months, P = 0.04), and had poorer transplant-free survival (P = 0.04) than high GGT group. Conclusions: 12.3% of infants with BA had normal GGT levels at diagnosis. Low GGT levels at presentation in BA was associated with a poorer outcome.

2D shear wave elastography combined with age and serum biomarkers prior to kasai surgery predicts native liver survival of biliary atresia infants

“…Previous studies have shown that a lower APRI at the time of KPE could predict a longer NLS [19,20], which is consisted with our findings. We also demonstrated that patients with low serum GGT levels prior to Kasai surgery were more likely to have poor prognosis, which was similar to that in several previous studies [15,16]. Studies [31,32] showed serum bilirubin level and ALB level could also influence NLS.…”

“…It has been shown that some preoperative parameters correlate well with the outcomes of KPE for BA infants. Studies have reported that a younger age was associated with a more favourable outcome [9][10][11][12][13][14], while low gamma-glutamyl transferase (GGT) level predicted a poor outcome in BA [15,16]. Other studies [11,[17][18][19][20] noted that the hepatic fibrosis stage and aspartate aminotransferase-to-platelet ratio (APRI) could be used to predict transplant-free survival time.…”

A Novel Model for Predicting the Clearance of Jaundice in Patients With Biliary Atresia After Kasai Procedure

“…Sun et al found that the preoperative GGT level in BA patients who survived for >5 years with normal liver function was significantly higher than in those who died from liver failure within a year post- KP ( 25 ). Besides, Shankar et al retrospectively analyzed 113 BA patients and found that 12.3% of patients with preoperative GGT <200 IU/L experienced a shorter time from the KP to liver transplantation and poorer transplant-free survival than those with preoperative GGT > 200 IU/L ( 26 ). These results seemed to suggest that a low preoperative level of GGT may be associated with poor prognosis after KP.…”

Value of serum GGT level in the timing of diagnosis of choledochal cyst perforation

“…Thus, a non-invasive and objective serum biomarker is clinically superior. Serum GGT levels were used to predict biliary atresia, however, its accuracy varied ( 19 , 20 ). Some studies also included GGT levels to develop a grading system (Grade I–III) for bile leakage severity in CC, with the serum GGT level for a Grade I diagnosis being 343.75 ± 215.6 U/L ( 6 ).…”