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Jingying Jiang, MD - Best of the Best in Pediatric Surgery 2024
With Dr. Zhang Jing
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Biliary Atresia 26 items
Chapter 1 of 6 · Fundamentals
Introduction
Introduction to presentation on biliary atresia and MMP-7
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What the experts said
Biliary atresia is a severe liver disease characterized by fibro-inflammatory destruction of bile ducts.
The study reviewed 329 BA patients who underwent Kasai procedure from 2020 to 2022.
Patients were divided into low MMP-7 and high MMP-7 groups based on preoperative MMP-7 levels of 20-25 ng/mL.
The median MMP-7 level for low MMP-7 group was 20.19 ng/mL compared with 66.55 ng/mL for the high MMP-7 group.
Preoperative gamma-GT and direct bilirubin in the low MMP-7 group were significantly lower than those in the high MMP-7 group.
Fibrosis stages were significantly different between the low and high MMP-7 groups.
Three-month jaundice clearance rate was 46.91% for the high MMP-7 group and 29.73% for the low MMP-7 group.
Six-month jaundice clearance rate was 54.51% for the high MMP-7 group and 32.14% for the low MMP-7 group.
A total of 90 patients in the low MMP-7 group and 112 patients in the high MMP-7 group died or underwent liver transplantation by the latest follow-up.
One-year native liver survival rate was 29.63% for the low MMP-7 group and 53.02% for the high MMP-7 group.
Around 10% of BA patients have low MMP-7 levels.
BA patients in the low MMP-7 group had a lower jaundice clearance rate and native liver survival rate.
The follow-up period ranged from 3 months to 3 years.
Some patients lost to follow-up within 3 months were excluded from final analysis.
Patients did not take MMP-7 measurements post-Kasai procedure in this study.
MMP-7 measurement is based on ELISA method.
MMP-7 testing is not very popular in every hospital in China, just in some institutions.
MMP-7 testing costs about 1000 RMB per patient in China.
Kasai procedure is still the first line treatment for biliary atresia.
Some BA patients could not achieve jaundice clearance and could not live long with their native liver after Kasai.
If the mechanism of MMP-7 in biliary atresia becomes clear, patients with low MMP-7 might go directly for liver transplantation in the future.
MMP-7 can help precisely discriminate BA from other cholestatic diseases at a cutoff value of around 20 ng/mL.
5 to 10% of BA patients have false negative MMP-7 levels.
Low gamma-GT levels correlated with more severe liver injury and poor outcomes in a previous study.