ArticleQuantitative imaging in medicine and surgery2026
Comparison of preoperative serum MMP-7 to liver two-dimensional shear wave elastography and its integration into a novel nomogram for predicting the native liver survival of infants with biliary atresia.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Biliary atresia (BA) is a rare and severe cholangiopathy. Accurate prediction of outcomes following Kasai portoenterostomy (KPE) is crucial for guiding individualized treatment strategies. This study primarily aimed to investigate the prognostic value of various laboratory biomarkers, including preoperative serum matrix metalloproteinase-7 (MMP-7) level. Methods: This prospective cohort study included consecutive infants with conjugated hyperbilirubinemia who were evaluated with serum MMP-7, liver two-dimensional shear wave elastography (2D-SWE), and other laboratory tests from July 2020 to September 2024. The reference standard for diagnosis was intraoperative cholangiography. We recorded the follow-up of native liver survival (NLS) time post-KPE longer than 2 years. Area under the curve (AUC) analysis, Kaplan-Meier survival analysis, Cox regression analyses, and establishment of an NLS nomogram were performed. Results: A total of 154 patients (median age 66 days), including 83 BA infants and 71 non-BA cholestatic infants, were included in the study. Serum MMP-7 distinguished infants with BA from other cholestatic infants, with a high diagnostic AUC of 0.95 [95% confidence interval (CI): 0.91-0.99]. Multivariate Cox regression analysis identified serum MMP-7 [hazard ratio (HR) 3.31], serum γ-glutamyltransferase (GGT) (HR 3.81), age at surgery (HR 2.21), and liver 2D-SWE (HR 11.47) as independent risk factors for NLS. An NLS nomogram based on the serum MMP-7, serum GGT, and age at surgery achieved a concordance index of 0.76 (95% CI: 0.67-0.85). A risk score was also established to stratify high-risk and low-risk patients post-KPE. Conclusions: The preoperative serum MMP-7 is valuable for predicting post-KPE prognosis. The novel nomogram and risk score effectively predict NLS following KPE, offering critical and practical guidance for optimizing BA treatment strategies.
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