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Acoustic radiation force impulse sonography in assessing children with biliary atresia for liver transplantation

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Abstract

Background

Children with biliary atresia are prone to developing progressive hepatic fibrosis and biliary cirrhosis following the Kasai operation. The only treatment is liver transplantation.

Objective

To assess liver fibrosis by acoustic radiation force impulse elastography (ARFI) in children who had Kasai operation, with the goal of identifying an ARFI value cut-off for children requiring liver transplantation.

Materials and methods

Of the 32 post-Kasai children included, 19 were transplanted or listed for transplantation (group A), while 13 were not on the list during their follow-up (group B). We recorded biopsies, blood samples and ARFI values over time, including at Kasai operation and at transplantation. We estimated an association between groups and continuous variables using generalized estimating equations, and we compared categorical variables using the Fisher exact test.

Results

Portal hypertension signs were similar in both groups, whereas ARFI values were higher in group A (mean±standard deviation=3.3±1.2 m/s) than in group B (2.0±0.7 m/s; P=.0003). Eighteen of 19 (94.7%) children in group A and 6/13 (46.2%) children in group B presented with two consecutive ARFI values ≥2 m/s (sensitivity=7%, specificity=53.8%; P=0.003).

Conclusion

We found that children who were transplanted had two consecutive ARFI values ≥2 m/s during follow-up. ARFI for evaluation of post-Kasai liver fibrosis may assist the long-term assessment of biliary atresia and may even guide treatment decisions.

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Acknowledgments

We tank Isabelle Bosquet, pediatric radiology nurse at Children’s Hospital Geneva, Switzerland, for data management.

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Authors and Affiliations

  1. Department of Pediatric Radiology, Children’s University Hospital of Geneva, 6 rue Willy Donzé, Ch 1211, Genève 14, Switzerland

    Sylviane Hanquinet, Laura Merlini & Mehrak Anooshiravani

  2. Division of Quality of Care, University Hospital of Geneva, Geneva, Switzerland

    Delphine S. Courvoisier

  3. Division of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland

    Anne-Laure Rougemont

  4. Department of Pediatric Surgery, Children’s University Hospital of Geneva, Geneva, Switzerland

    Barbara E. Wildhaber

  5. Department of Pediatric Gastroenterology, Children’s University Hospital of Geneva, Geneva, Switzerland

    Valérie A. McLin

Authors
  1. Sylviane Hanquinet
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  2. Delphine S. Courvoisier
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  3. Anne-Laure Rougemont
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  4. Barbara E. Wildhaber
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  5. Laura Merlini
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  6. Valérie A. McLin
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  7. Mehrak Anooshiravani
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Correspondence to Sylviane Hanquinet.

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Hanquinet, S., Courvoisier, D.S., Rougemont, AL. et al. Acoustic radiation force impulse sonography in assessing children with biliary atresia for liver transplantation. Pediatr Radiol 46, 1011–1016 (2016). https://doi.org/10.1007/s00247-016-3565-3

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  • DOI: https://doi.org/10.1007/s00247-016-3565-3

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