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Poster - 173
Predictive Value of Preoperative APRI for Native Liver Survival in Biliary Atresia
Gökay Gökdeniz 1, Önder Özden 1, Recep Tuncer 1, Şeref Selçuk Kılıç 1, Selcan Türker Çolak 1, Kamuran Tutuş 1, Kıvılcım Eren Ateş 2
1 Cukurova University Faculty of Medicine Department of Pediatric Surgery
2 Cukurova University Faculty of Medicine Department of Pathology
Introduction: Biliary atresia (BA) is a progressive, fibro-obstructive cholangiopathy of infancy. Timely Kasai portoenterostomy (KPE) improves outcomes, yet prognostic biomarkers for surgical success remain limited. This study aimed to evaluate the Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) as a non-invasive predictor of native liver survival (NLS) and clearance of jaundice(COJ) after KPE.
Methods:
We retrospectively reviewed 62 infants who underwent KPE between 2007 and 2023. Preoperative APRI scores were calculated using AST and platelet counts. Additional data included liver histopathology (fibrosis, bile duct proliferation, ductal plate malformation) and CMV IgM serology. Primary outcomes were NLS and COJ (bilirubin <2 mg/dL at 6 months postoperatively). ROC analysis was performed to determine optimal APRI cut-offs.
Results:
Among 62 patients (32F/30M), NLS was achieved in 30.6% (n=19) and COJ in 24.2% (n=15). Lower APRI scores were significantly associated with both NLS (0.8±0.5 vs. 2.2±4.2, p=0.035) and COJ (p=0.009). ROC analysis identified an APRI cut-off ≤0.65 for NLS (sensitivity: 74%, specificity: 52%) and jaundice clearance (sensitivity: 78.5%, specificity: 80%). CMV IgM positivity correlated with higher APRI (p=0.015) but had no significant impact on NLS. APRI did not correlate with histological fibrosis.
Conclusion:
Preoperative APRI is a simple, cost-effective, and non-invasive biomarker that predicts native liver survival and COJ following KPE. While it does not correlate with histological fibrosis, APRI may better reflect liver inflammation and function. Its inclusion in preoperative assessment could aid risk stratification, and we recommend integrating APRI into standard preoperative evaluation protocols, particularly in resource-limited settings.