ArticlePediatric surgery international2026
Preoperative porta hepatis-to-hepatic surface ratio on 24-h delayed hepatobiliary scintigraphy is associated with jaundice clearance after Kasai portoenterostomy.
Article in Pediatric surgery international, 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
purposeBiliary atresia (BA) often requires liver transplantation despite Kasai portoenterostomy (KPE). The prognostic role of hepatobiliary scintigraphy remains unclear.
methodsTwenty-three infants undergoing KPE between 2017 and 2024 were retrospectively analyzed. Patients without 6-h bowel activity on technetium-99 m PMT hepatobiliary scintigraphy underwent 24-h delayed imaging. The primary endpoint was jaundice clearance (total bilirubin < 2 mg/dL within 3 months). Ancillary analyses included an internally validated receiver operating characteristic (ROC) cutoff and correlation of the 24-h porta hepatis-to-hepatic surface (PH/HS) ratio with 1-year bilirubin, native liver survival (NLS), and portal plate bile duct diameter.
resultsSixteen infants achieved jaundice clearance, and their 24-h PH/HS ratio was higher (1.20 vs. 1.11, p = 0.049). ROC analysis identified an exploratory cutoff of 1.15 (apparent area under the curve [AUC], 0.768; internally validated AUC, 0.670). Excluding patients transplanted within 1 year, the PH/HS ratio correlated inversely with 1-year bilirubin (r = - 0.720). NLS did not differ significantly between groups, and the association with portal plate bile duct diameter was weak.
conclusionsThe 24-h PH/HS ratio was associated with post-KPE jaundice clearance. However, these findings remain preliminary and hypothesis-generating. As a noninvasive preoperative parameter beyond routine laboratory testing, the PH/HS ratio warrants prospective multicenter validation.
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