Preoperative porta hepatis-to-hepatic surface ratio on 24-h delayed hepatobiliary scintigraphy is associated with jaundice clearance after Kasai portoenterostomy.

چکیده اصلی

PURPOSE: Biliary atresia (BA) often requires liver transplantation despite Kasai portoenterostomy (KPE). The prognostic role of hepatobiliary scintigraphy remains unclear. METHODS: Twenty-three infants undergoing KPE between 2017 and 2024 were retrospectively analyzed. Patients without 6-h bowel activity on technetium-99 m PMT hepatobiliary scintigraphy underwent 24-h delayed imaging. The primary endpoint was jaundice clearance (total bilirubin < 2 mg/dL within 3 months). Ancillary analyses included an internally validated receiver operating characteristic (ROC) cutoff and correlation of the 24-h porta hepatis-to-hepatic surface (PH/HS) ratio with 1-year bilirubin, native liver survival (NLS), and portal plate bile duct diameter. RESULTS: Sixteen infants achieved jaundice clearance, and their 24-h PH/HS ratio was higher (1.20 vs. 1.11, p = 0.049). ROC analysis identified an exploratory cutoff of 1.15 (apparent area under the curve [AUC], 0.768; internally validated AUC, 0.670). Excluding patients transplanted within 1 year, the PH/HS ratio correlated inversely with 1-year bilirubin (r = - 0.720). NLS did not differ significantly between groups, and the association with portal plate bile duct diameter was weak. CONCLUSIONS: The 24-h PH/HS ratio was associated with post-KPE jaundice clearance. However, these findings remain preliminary and hypothesis-generating. As a noninvasive preoperative parameter beyond routine laboratory testing, the PH/HS ratio warrants prospective multicenter validation.

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