Journal of Clinical and Experimental Hepatology最新文献

{"title":"Therapeutic Options for the Management of the Cholestatic Phase of Viral Hepatitis A and E—A Systematic Review","authors":"Suprabhat Giri ,&nbsp;Gaurav Khatana ,&nbsp;Prasanna Gore ,&nbsp;Dibya L. Praharaj ,&nbsp;Anand V. Kulkarni ,&nbsp;Anil C. Anand","doi":"10.1016/j.jceh.2025.102557","DOIUrl":"10.1016/j.jceh.2025.102557","url":null,"abstract":"<div><h3>Background/Aims</h3><div>The cholestatic hepatitis associated with acute viral hepatitis leads to prolonged jaundice and pruritus. While several treatment approaches have been proposed, there is a noticeable absence of agreement over the most effective course of action. The goal of this systematic review is to compile and assess the available data on treatment approaches for prolonged hepatitis associated with viral hepatitis.</div></div><div><h3>Methods</h3><div>We comprehensively searched for relevant studies in MEDLINE, Embase, and Scopus from their inception to May 2024. Studies reporting the treatment option for the management of the cholestatic phase associated with viral hepatitis were included.</div></div><div><h3>Results</h3><div>A total of 28 studies describing 164 patients were included in the review, of which 18 were case reports, 8 were case series, and 2 were interventional studies. The benefit of ursodeoxycholic acid (UDCA) was reported in two case reports, with doses varying from 10 to 30 mg/kg/d in the included studies. The use of corticosteroids in adult patients was reported in 21 studies, with prednisolone doses varying from 30 to 60 mg/day in adults. Two studies used nasobiliary drain (NBD) for patients who failed to respond to conventional therapy. Lastly, three studies reported using plasma exchange (PLEX) in patients refractory to standard treatment.</div></div><div><h3>Conclusion</h3><div>Patients not responding to UDCA or cholestyramine may benefit from a short course of corticosteroids, suggesting an immune-mediated phenomenon. NBD placement or PLEX may be tried after analyzing the risk-to-benefit ratio for patients who are nonresponsive to corticosteroids. Further research is required to determine the optimal treatment strategy.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 5","pages":"Article 102557"},"PeriodicalIF":3.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world Prevalence of Hepatitis B Reactivation in Patients With Resolved Hepatitis B Receiving Rituximab and Non-rituximab-based Immunosuppressive Therapy Without Chemoprophylaxis","authors":"Valerie Yeap,&nbsp;Wei-Lun Liou,&nbsp;Gayathry Morvil,&nbsp;Rajneesh Kumar","doi":"10.1016/j.jceh.2025.102551","DOIUrl":"10.1016/j.jceh.2025.102551","url":null,"abstract":"<div><h3>Background</h3><div>Hepatitis B virus reactivation (HBVr) can occur in patients with resolved hepatitis B virus (HBV) infection receiving immunosuppressive therapy. The class of immunosuppression influences HBV reactivation (HBVr) risk, with B-cell depleting agents such as Rituximab conferring a higher risk. The presence of hepatitis B surface antibodies (HBsAb) may be protective against HBVr.</div></div><div><h3>Objective</h3><div>To compare the rates of HBVr amongst individuals with resolved HBV infection receiving rituximab and non-rituximab immunosuppressive therapy, without chemoprophylaxis. Our secondary objective was to explore the role of HBsAb in risk stratification for HBVr.</div></div><div><h3>Methods</h3><div>We retrospectively collected the data of patients with resolved HBV infection receiving immunosuppressants between 2014 and 2022. HBVr rates amongst patients receiving rituximab and non-rituximab therapy were compared. Logistic regression analysis was performed to identify risk factors for HBVr.</div></div><div><h3>Results</h3><div>148 patients with resolved HBV infection did not receive chemoprophylaxis. Of the 20 (13.5%) patients who developed HBVr, none developed HBV flare. 42 of the 148 (28.3%) patients received rituximab-based therapy. Patients who received rituximab had a higher risk of HBVr, 12(28.6%) vs 8(7.5%), <em>P</em> = 0.001. This was confirmed on multivariable analysis (OR 4.19 [C.I. 1.47–11.9], <em>P</em> = 0.007). HBsAb titres of above 100 mIU/ml were protective against HBVr (OR 0.04 [CI 0.001–0.84], <em>P</em> = 0.039) in the rituximab exposed cohort, but not in the non-rituximab exposed cohort.</div></div><div><h3>Conclusion</h3><div>The risk of HBVr was higher in patients receiving rituximab; however, no patient developed HBV flare. In patients with resolved HBV infection, the presence of HBsAb titres above 100 mIU/ml may confer additional protection against HBVr and can be used as part of risk stratification for HBVr. In such patients, close surveillance with on-demand therapy instead of chemoprophylaxis may be considered.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102551"},"PeriodicalIF":3.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Bile Acid Elevation is an Independently Associated With Pruritus in Patients With At-risk Metabolic Dysfunction-associated Steatotic Liver Disease","authors":"Zobair M. Younossi ,&nbsp;Michael J. Estep ,&nbsp;Sean Felix ,&nbsp;Brian Lam ,&nbsp;Sumanta Mukherjee ,&nbsp;Brandon Swift ,&nbsp;Linda Casillas ,&nbsp;Andrea R. de Souza ,&nbsp;Jake Hunnicutt ,&nbsp;Megan M. McLaughlin ,&nbsp;Andrei Racila ,&nbsp;Fatema Nader ,&nbsp;Maria Stepanova","doi":"10.1016/j.jceh.2025.102549","DOIUrl":"10.1016/j.jceh.2025.102549","url":null,"abstract":"<div><h3>Background and aims</h3><div>Elevated serum bile acids are associated with pruritus in cholestatic liver diseases. We assessed the association of serum bile acids and other putative biomarkers of cholestatic pruritus (autotaxin and interleukin-31 (IL-31) with pruritus in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).</div></div><div><h3>Methods</h3><div>We used serum from patients with MASLD and metabolic dysfunction-associated steatohepatitis (MASH), viral hepatitis B, viral hepatitis C, and healthy blood donors to measure the levels of bile acids, autotaxin, and IL-31. Clinically significant pruritus was defined from the Chronic Liver Disease Questionnaire.</div></div><div><h3>Results</h3><div>Six hundred fifty-one subjects were included [MASLD (N = 497, 88 MASH), viral hepatitis B and C (VH, N = 98), healthy controls (N = 56)]. Post hoc definitions of high biomarker levels associated with the presence of clinically significant pruritus were as follows: high bile acids ≥5.9 μmol/L, high autotaxin ≥220 ng/mL, and high IL-31 ≥ 25 pg/mL. The VH patients had the highest bile acids levels and lowest levels were in healthy controls (<em>P</em> &lt; 0.0001). The highest autotaxin levels were seen in hepatitis C, while the highest IL-31 levels in MASH. MASH patients had higher levels of all three biomarkers than non-MASH-MASLD. Also, at-risk MASLD or MASLD with advanced fibrosis (AF) had higher bile acids and autotaxin (all <em>P</em> &lt; 0.01) but not IL-31 (<em>P</em> &gt; 0.05). MASLD patients with high bile acids had more pruritus (all MASLD: 25% vs. 17%; MASH 30% vs. 13%; at-risk MASLD: 33% vs. 12%; AF: 41% vs. 8%). In multivariable logistic regressions, having high bile acids was an independent predictor of pruritus in at-risk MASLD [odds ratio (OR) (95% CI) = 4.4 (1.6–12.1)] and MASLD with advanced fibrosis [OR = 7.5 (2.0–29.0)]; but not autotaxin or IL-31 (all <em>P</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>High serum bile acid level is independently associated with pruritus in at-risk MASLD.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102549"},"PeriodicalIF":3.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Tenofovir Plus Entecavir Combination Therapy Versus Tenofovir Monotherapy in Chronic Hepatitis B Virus Patients With Resistance or Partial Response to Entecavir: A Systematic Review and Meta-analysis","authors":"Syed H. Ali ,&nbsp;Muhammad H. Shah ,&nbsp;Sakshi Roy ,&nbsp;Hareesha R. Bharadwaj ,&nbsp;Joecelyn K. Tan ,&nbsp;Medha S. Rao ,&nbsp;Muhtasim Fuad ,&nbsp;Arjun Ahluwalia ,&nbsp;Aditya Gaur ,&nbsp;Priyal Dalal ,&nbsp;Arkadeep Dhali ,&nbsp;Harishankar Gopakumar","doi":"10.1016/j.jceh.2025.102541","DOIUrl":"10.1016/j.jceh.2025.102541","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Chronic hepatitis B virus remains a significant cause of liver disease in the developing world, leading to sequelae such as hepatocellular carcinoma. While entecavir (ETV) serves as a first-line treatment, its growing resistance rates underscore the need to explore viable alternatives. Tenofovir disoproxil fumarate (TDF) monotherapy and entecavir plus tenofovir (TDF + ETV) combination therapy are both employed as treatments, but one's efficacy over another is in question. This meta-analysis aims to investigate any primacy of either treatment.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive literature search across PubMed/Medline, Embase, Cochrane Central, Web of Science, and China National Knowledge Infrastructure from inception till 7th October 2024. Studies comparing the safety and efficacy of TDF monotherapy versus TDF + ETV combination therapy in patients resistant to entecavir were considered. Data about the virologic response (VR), virologic breakthrough, HbeAg seroconversion, HbeAg/HbsAg seroclearance, and alanine aminotransferase normalization were extracted. Relative risks (RRs) and their corresponding 95% confidence intervals (CIs) were calculated, pooled, and analyzed in a random-effects model. <em>P</em>-value &lt;0.05 was regarded as significant for all analyses.</div></div><div><h3>Results</h3><div>Nine studies, comprising 335 patients undergoing monotherapy and 352 patients undergoing combination therapy, satisfied the criteria. TDF + ETV combination therapy was found slightly advantageous to TDF monotherapy, stimulating a VR at 48 weeks (RR 1.081 95% CI: [1.001–1.167] <em>P</em> = 0.046, I2 = 0%), along with the HbeAg seroconversion rate (RR 1.711 95% CI: [1.005–2.913] <em>P</em> = 0.048, I2 = 0%). There were no significant adverse events in individual studies to warrant a meta-analysis.</div></div><div><h3>Conclusions</h3><div>TDF + ETV shows slightly better efficacy to TDF monotherapy over a 48-week treatment regimen, with minimal safety concerns. However, further high-quality studies like randomized controlled trials are needed to further solidify conclusions, with this meta-analysis only achieving borderline significances.</div></div><div><h3>Registration</h3><div>This review is registered on the PROSPERO database (ID: CRD42024581443).</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102541"},"PeriodicalIF":3.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving Landscape of Systemic Therapy for Hepatocellular Carcinoma in 2025","authors":"Karan Kumar,&nbsp;Vivek A. Saraswat","doi":"10.1016/j.jceh.2025.102547","DOIUrl":"10.1016/j.jceh.2025.102547","url":null,"abstract":"<div><div>Hepatocellular carcinoma (HCC), the sixth most common malignant tumor, accounts for approximately 90% of liver cancers. HCC is frequently diagnosed at an advanced stage, where systemic therapy becomes the primary treatment option. As understanding about the molecular signaling pathways within tumors and the tumor microenvironment have evolved, treatment option for advanced HCC has also become more innovative. Current therapies target cellular pathways, including tyrosine kinase inhibitors (TKIs) like lenvatinib, sorafenib, regorafenib, and cabozantinib, which disrupt signals crucial for tumor growth and survival; VEGF (vascular endothelial growth factor) inhibitors that block tumor blood vessel formation; and immunotherapy agents such as atezolizumab-bevacizumab, tremelimumab, and durvalumab, which stimulate the immune system to attack cancer cells. Both targeted therapies and immunotherapies, used alone or in combination, have demonstrated efficacy in clinical trials. The treatment landscape for HCC is rapidly evolving, driven by recent landmark trial results exploring innovative strategies and drug combinations. This review examines these exciting advancements in systemic therapy, highlighting their transformative potential and the promise of more effective, personalized treatment regimens. These developments offer hope for improved patient outcomes and a deeper understanding of this complex disease.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 5","pages":"Article 102547"},"PeriodicalIF":3.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the Complexities of Hepatocellular Carcinoma Management: Optimizing Liver Transplantation Outcomes Through a Multifaceted Approach","authors":"Sumana Kolar Ramachandra,&nbsp;G. Venkata Rao","doi":"10.1016/j.jceh.2025.102548","DOIUrl":"10.1016/j.jceh.2025.102548","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102548"},"PeriodicalIF":3.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143746732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Mortality in Patients Diagnosed With Autoimmune Hepatitis – Insights from a Prospective, 90-day Follow--up Study","authors":"Harsh J. Gandhi ,&nbsp;Shubham Jain ,&nbsp;Sanjay Chandnani ,&nbsp;Rishikesh N. Malokar ,&nbsp;Jay Chudasama ,&nbsp;Sameet Patel ,&nbsp;Deepika Pandey ,&nbsp;Vishal Mavuri ,&nbsp;Rima Kamat ,&nbsp;Pravin Rathi","doi":"10.1016/j.jceh.2025.102546","DOIUrl":"10.1016/j.jceh.2025.102546","url":null,"abstract":"<div><h3>Background and aims</h3><div>The response to corticosteroids and optimal timing for liver transplantation (LT) in patients with autoimmune hepatitis (AIH) remain significant clinical challenges. This study aimed to assess short-term (90-day) mortality in patients with acute AIH (with or without underlying cirrhosis and chronic liver disease) treated with corticosteroids, and to identify factors that predict mortality in this population.</div></div><div><h3>Methods</h3><div>We conducted a prospective, single-center study between 2022 and 2024, involving patients with histologically confirmed AIH. All patients received corticosteroid treatment and were monitored for various clinical and laboratory parameters on days 3, 7, and 90 after initiating therapy.</div></div><div><h3>Results</h3><div>A total of 104 patients were included in the study, with a mean age of 46.1 ± 14.3 years; 77% of the patients were female. The 90-day mortality rate following the initiation of corticosteroids was 13.47%. Univariate analysis identified several significant predictors of mortality, including older age, diabetes mellitus, cirrhosis, esophageal varices, hepatic encephalopathy, low serum albumin on day 3, model of end-stage liver disease (MELD) scores on days 3 and 7, and the survival and prognostic factors for acute severe autoimmune hepatitis (SURFASA) score (<em>P</em> &lt; 0.05). Multivariate analysis revealed that MELD score on day 7 (odds ratio [OR] 1.25; 95% confidence interval [CI] {1.09–1.48}; <em>P</em> = 0.00) and SURFASA score (OR 7.46; 95% CI {1.05–53.06}; <em>P</em> = 0.04) were significant. Specifically, a MELD score ≥27.5 on day 7 (area under the receiver operating characteristic curve [AUC] = 0.998) with 100% sensitivity and 97.8% specificity, and a SURFASA score ≥ −2.95 (AUC = 0.969) with 100% sensitivity and 95.6% specificity were highly predictive of mortality.</div></div><div><h3>Conclusion</h3><div>Despite corticosteroid treatment, mortality rates remain high in the decompensated AIH and acute on chronic liver failure–AIH groups. The SURFASA score, along with MELD scores on days 3 and 7, are strong predictors of mortality and can assist clinicians in making timely decisions regarding referral for early liver transplantation.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102546"},"PeriodicalIF":3.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic and Alcohol-associated Liver Disease and its Place in the Spectrum of Steatotic Liver Disease","authors":"Stephanie M. Rutledge,&nbsp;Gene Y. Im","doi":"10.1016/j.jceh.2025.102545","DOIUrl":"10.1016/j.jceh.2025.102545","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102545"},"PeriodicalIF":3.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of Two Prognostic Gene Scores in Patients Undergoing Liver Resection for Hepatocellular Carcinoma","authors":"Stinna D. Schnabl ,&nbsp;Jeanett Klubien ,&nbsp;Colm J. O'Rourke ,&nbsp;Sophie Bull Nordkild ,&nbsp;Jan-Michael Kugler ,&nbsp;Susanne Dam Nielsen ,&nbsp;Jesper B. Andersen ,&nbsp;Hans-Christian Pommergaard","doi":"10.1016/j.jceh.2025.102544","DOIUrl":"10.1016/j.jceh.2025.102544","url":null,"abstract":"<div><h3>Background/Aims</h3><div>Several prognostic gene signatures have been proposed as predictors of the prognosis of hepatocellular carcinoma (HCC), yet none are implemented in the clinical setting. We aimed to validate two gene scores previously derived from European cohorts.</div></div><div><h3>Methods</h3><div>The patients who underwent liver resection for HCC at Copenhagen University Hospital, Rigshospitalet from 2014 to 2018 were included. RNA sequencing determined the expression of genes in the ‘<em>5-gene score</em>’ (<em>HN1, RAN, RAMP3, KRT19, TAF9B</em>) and ‘<em>HepatoPredict’</em> (<em>CLU, DPT, SPRY2, CAPSN1</em>). Univariable Cox regression assessed associations with overall and disease-free survival. These parameters were also analyzed in the The Cancer Genome Atlas Liver Hepatocellular Carcinoma (TCGA-LIHC) (n = 359) and National Institute of Health (NIH) (n = 178) cohorts.</div></div><div><h3>Results</h3><div>Among 51 patients (88% male), 59% had no underlying liver disease and 25% had cirrhosis. No individual genes were significantly associated with overall survival in the Danish cohort. In the TCGA-LIHC cohort, <em>CLU</em> was linked to better overall survival, and in the NIH cohort, high expression of <em>SPRY2</em> was associated with poorer overall survival. In the TCGA-LIHC cohort, <em>HN1</em>, <em>RAN</em>, and <em>TAF9B</em> were associated with poorer overall survival, while <em>RAMP3</em> was linked to better overall survival. No genes were associated with disease-free survival.</div></div><div><h3>Conclusion</h3><div>Few individual genes significantly predicted survival in the larger cohorts, and none in the Danish cohort. However, the clinical implication of this needs further investigation.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102544"},"PeriodicalIF":3.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Transient Elastography in Differentiating Biliary Atresia from Other Causes of Neonatal Cholestasis: A Prospective Observational Study","authors":"Upasana Ghosh ,&nbsp;Ujjal Poddar ,&nbsp;Narendra Krishnani ,&nbsp;Vivek A. Saraswat ,&nbsp;Basant Kumar ,&nbsp;Moinak S. Sarma ,&nbsp;Anshu Srivastava ,&nbsp;Prabhaker Mishra","doi":"10.1016/j.jceh.2025.102543","DOIUrl":"10.1016/j.jceh.2025.102543","url":null,"abstract":"<div><h3>Background</h3><div>Differentiating biliary atresia (BA) from non-BA is paramount, as their management and outcome differ. So far, BA is diagnosed by intraoperative cholangiogram (IOC) or liver biopsy. However, literature is sparse on the utility of transient elastography (TE) in neonatal cholestasis. We aimed to study the usefulness and accuracy of TE in differentiating BA from other causes of neonatal cholestasis (NCS).</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted from June 2021 to February 2024; consecutive cases of NCS were recruited. Patients were grouped as BA and non-BA. All patients underwent clinical, laboratory, and radiological evaluation, along with TE. Receiver operating characteristic curve (ROC) analysis was performed to derive an LSM cutoff for diagnosing BA. The liver stiffness measurement (LSM) was correlated with histopathological fibrosis.</div></div><div><h3>Results</h3><div>We enrolled 135 patients, BA (n = 68) and non-BA (n = 67). The median LSM was higher in BA, 19.4 (12.9–38.75) kPa <em>vs</em>. 12.0 (8.4–17.9) kPa (<em>P</em>=&lt;0.001). LSM positively correlated with the METAVIR fibrosis score (Spearman's correlation coefficient, r = 0.590, <em>P</em> &lt; 0.001). We derived an LSM cutoff of 13.1 kPa to differentiate BA from non-BA (sensitivity 75%, specificity 61.2%, AUC 0.736). By adding ultrasound (USG) finding of a small gallbladder (&lt;19 mm) to our LSM cutoff (13.1 kPa), the sensitivity improved to 97.0%, but specificity remained low (52.2%).</div></div><div><h3>Conclusion</h3><div>LSM correlates well with histopathological fibrosis in NCS. An LSM cut off of 13.1 kPa can be used to differentiate BA from non-BA with a sensitivity of 75%. In resource-constraint setting where liver biopsy and IOC may not be available, TE in combination with USG can be a good screening tool for BA (sensitivity 97%).</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102543"},"PeriodicalIF":3.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}