Serum bile acid levels predict the development of portal hypertension and high-risk esophageal varices following successful Kasai in biliary atresia.

BACKGROUND AIMS Biliary atresia can lead to portal hypertension (PH), high-risk esophageal varices (HRV) and liver transplantation, despite successful Kasai procedure (KP). Serum bile acids (sBA) can reflect residual cholestasis in patients with successful KP. We investigated the predictive value of sBA measured during the first year post-KP on the development of PH and HRV within 5 years post-KP. APPROACH RESULTS In this retrospective monocentric observational study, we included biliary atresia patients who underwent a successful KP, defined as a total serum bilirubin level of ≤25 μmol/L within 6 months post-KP, and in whom sBA were measured during the first year post-KP (n=60). We collected clinical, biological and digestive endoscopic data up to 5 years post-KP to assess the occurrence of PH and HRV. Predictive values of sBA were analyzed using receiver operating characteristic curves. sBA measured at a median time of 6 months (range: 4.5-9) and of 11 months (range: 9-12) post-KP, predicted PH at 3 and 5 years post-KP, with AUCs between 0.89 and 0.93 (p<0.0003) and the occurrence of HRV before 5 years post-KP with AUCs between 0.74 and 0.75 (p<0.04). sBA thresholds of 56 μmol/L and 30 μmol/L at a median time of 6 and 11 months post-KP, respectively, predicted HRV within 5 years post-KP with a sensitivity of 100%. CONCLUSION In biliary atresia patients with successful KP, sBA is an early biomarker predicting the development of PH and HRV within 5 years post-KP.