Biomarkers of native liver survival and portal hypertension in biliary atresia

Abstract Objective To evaluate the prognostic value of noninvasive markers Aspartate Aminotransferase to Platelet Ratio Index (APRi) and Infantile Biliary Atresia Liver Fibrosis score (iBALF), as well as the histological Ishak fibrosis score, as predictors of native liver survival (NLS) and portal hypertension (PH) in children with biliary atresia BA undergoing Kasai portoenterostomy (KPE). Methods A single‐center, retrospective observational study was conducted on children diagnosed with BA who underwent KPE. APRi and iBALF were calculated using laboratory data collected at hospital discharge after KPE. The degree of hepatic fibrosis was assessed and reviewed using the Ishak fibrosis score in liver biopsy specimens collected at KPE. NLS was analyzed using Kaplan–Meier survival curves and Cox proportional hazards regression. A p ‐value < 0.05 was considered statistically significant. Results Higher APRi, iBALF, and Ishak fibrosis score values were associated with lower NLS ( p < 0.006, p < 0.025, and p < 0.048, respectively). APRi and iBALF emerged as good PH predictors ( p < 0.005 and p < 0.032, respectively). Conclusion APRi, iBALF, and the Ishak fibrosis score showed prognostic value in predicting NLS in children with BA after KPE. These findings reinforce the potential use of biomarkers in the clinical follow‐up of these patients, supporting risk stratification strategies.