Direct Bilirubin and Risk of Biliary Atresia.

BACKGROUND: Early detection of biliary atresia (BA) is important for optimal treatment. Direct bilirubin (D-bil) levels are used for BA screening. In this study, we aimed to determine the sensitivity and specificity of elevated D-bil and the direct-to-total bilirubin (D/T) ratio for BA detection in high-risk infants. METHODS: This retrospective, cross-sectional study was conducted in a tertiary medical center in Taiwan. Infants indicated for total bilirubin and D-bil measurements before age 60 days were included. The first bilirubin assessment was considered the test point. BA diagnosis was based on International Classification of Diseases, Ninth and Tenth Revision, codes 751.61 and Q44.0 to Q44.3, respectively. RESULTS: Between January 2009 and December 2016, 4468 infants were enrolled, including 38 with BA. Among infants aged 3 to 60 days, a sensitivity of 100% (95% confidence interval, 90.3-100.0) was found for D-bil ≥1.0 mg/dL and either D-bil ≥1.0 mg/dL or D/T ratio ≥20%. However, D-bil ≥1.0 mg/dL had higher specificity (77.3% [76.0-78.5] vs 68.3% [66.8-69.7], respectively). In newborns aged <3 days, D-bil ≥0.5 mg/dL was considered a positive result, with a sensitivity of 50%. D-bil >0.45 mg/dL was a better cutoff point in receiver operating characteristic analysis, with a sensitivity and specificity of 100% (95% CI: 15.8-100) and 15.4% (95% CI, 11.8-19.7), respectively. CONCLUSIONS: D-bil ≥1.0 mg/dL was better for BA detection than the D/T ratio in infants aged 3 to 60 days. For newborns aged <3 days, a more definitive cutoff point is required.

Resistance index of hepatic artery can predict anastomotic biliary complications after liver transplantation in children.

BACKGROUND/PURPOSE: Biliary complications remain a major morbidity after liver transplantation in children. Inadequate arterial supply to the bile duct after transplantation plays an important role in developing anastomotic biliary complications. We aimed to elucidate the relationship between the resistance index (RI) of hepatic artery and the anastomotic biliary complications after liver transplantation in children. METHODS: This is a retrospective, case-control design study. We enrolled 11 pediatric patients under 18 years of age with anastomotic biliary complication after liver transplantation and another 26 matched pediatric transplanted patients without biliary complication as the control group. All patients received liver Doppler ultrasonography within 15 months after liver transplantation. We focused on the ultrasound parameters including waveforms, RI and acceleration time (AT) of hepatic artery. RESULTS: We used the receiver operating characteristic curve to analyze the RI in these 37 patients and yielded a cutoff of RI â‰¦ 0.57 (63.6% sensitivity and 92.3% specificity) for the best prediction of anastomotic biliary complications. Patients with RI â‰¦ 0.57 have a higher chance of having biliary complications, with an Odds ratio of 21 (95% CI = 3.16-139.66). The Cox's proportional hazard analysis also confirmed the significance of RI â‰¦ 0.57 in predicting biliary complications (Hazard ratio = 8.11, 95% CI = 2.35-28.01, P = 0.001) after liver transplantation in children. Three (27.3%) patients with biliary complications received hepatojejunostomy reconstruction, and another 8 patients (72.7%) were successfully managed by percutaneous biliary intervention alone. CONCLUSION: The RI of hepatic artery ≦0.57 may serve as an important non-invasive predictor for anastomotic biliary complications after liver transplantation in children.