The characteristics of liver nodules in biliary atresia native liver survivors

Abstract Purpose To delineate features of hepatic nodules in native liver survivors (NLS) of biliary atresia (BA) post-Kasai portoenterostomy (KPE) and determine the surveillance utility of tumour markers and imaging studies. Methods This retrospective study conducted in a tertiary referral centre evaluated post-KPE patients who developed liver nodules following operations performed between 1979–2020. These included NLS at time of writing and liver transplant (LT) recipients with evidence of nodules before LT. Demographic, biochemistry, tumour markers, imaging, and histopathological data were collected. Dysplastic and non-dysplastic nodules were compared using Mann-Whitney U and Fisher’s exact test. Results Among 163 BA patients, of 96 NLS, 17 developed nodules; of 67 post-LT patients, 6 developed nodules before LT. Together, 23 post-KPE patients with nodules were analyzed: 4 dysplastic (one progressed into early hepatocellular carcinoma) and 19 benign lesions. Dysplastic nodules appeared earlier (8.2 vs. 21.2 years, p=0.286) and were larger (11.6 vs. 2.2cm 2 , p=0.284). Alpha-fetoprotein (AFP) levels were similar (2.0ng/mL vs. 3.0ng/mL, p=0.232). All dysplastic nodules exhibited arterial-phase enhancement without portovenous washout on contrast-enhanced computed tomography (CT). Conclusion In BA NLS, one-quarter develop hepatic nodules over time; malignant changes are rare, but can occur. Additionally, contrast-enhanced CT surveillance may be useful for larger, or earlier-detected hepatic nodules.