The Predictive Value of Gamma-Glutamyl Transferase on Jaundice Clearance in Biliary Atresia: An Evidence-Based Case Report and Meta-Analysis

Authors

  • Megan Quinka D Toding Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Awliya Syamsul Munir Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Mutiara Ramadhanty Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Lowilius Wiyono Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

DOI:

https://doi.org/10.58427/apghn.3.3.2024.20-31

Keywords:

biliary atresia, gamma-glutamyl transferase, jaundice clearance, kasai surgery, prognosis

Abstract

Background: Biliary atresia (BA) is a neonatal condition characterized by the obstruction of extrahepatic bile ducts.

Case: A 2-year-old female with BA underwent a Kasai procedure at 3 months of age. Despite the surgery, she developed persistent jaundice and abdominal enlargement. Preoperative laboratory findings revealed elevated liver enzymes, GGT, and bilirubin levels. This case raises the clinical question of whether preoperative GGT levels can predict JC after the Kasai procedure, in addition to its role in diagnosis.

Methods: A systematic literature search was performed on 4 databases (PubMed, Scopus, Cochrane, and Proquest) by using relevant keywords and identified seven high quality studies.

Results: Five studies found higher GGT levels in patients who achieved JC following Kasai surgery, compared to those with unsuccessful jaundice clearance (JUC). However, two studies reported conflicting findings. A pooled analysis indicated a non-significant trend toward higher GGT levels in the JC group compared to the JUC group (WMD: 65.6, 95% CI: -58.6; 189.8).

Conclusion: Elevated preoperative GGT levels may be associated with improved JC in BA patients. However, further investigation to validate these findings, determine the optimal role of GGT in assessing prognosis, and later, guiding treatment decisions in BA patients.

References

Yassin NA, El-Tagy G, Abdelhakeem ON, Asem N, El-Karaksy H. Predictors of Short-Term Outcome of Kasai Portoenterostomy for Biliary Atresia in Infants: a Single-Center Study. Pediatr Gastroenterol Hepatol Nutr. 2020;23(3):266-75. https://doi.org/10.5223/pghn.2020.23.3.266 DOI: https://doi.org/10.5223/pghn.2020.23.3.266

Alhebbi H, El-Edreesi M, Abanemai M, Saadah O, Alhatlani M, Halabi H, et al. Clinical and laboratory features of biliary atresia and patterns of management practices: Saudi national study (2000-2018). Saudi J Gastroenterol. 2024;30(2):89-95. https://doi.org/10.4103/sjg.sjg_151_23 DOI: https://doi.org/10.4103/sjg.sjg_151_23

Qi Q, Wanga Y, Wub Q, Sua P, Wanga D, Lia T, Zhanga Z. Predicting the outcomes of Kasai portoenterostomy for biliary atresia: a cohort study. medRxiv. 2022:1-17. https://doi.org/10.1101/2022.10.06.22279593 DOI: https://doi.org/10.1101/2022.10.06.22279593

Zhang Y, Wang Q, Pu S, Wang J, Xiang B, Liu J, Jin S. A Novel Model for Predicting the Clearance of Jaundice in Patients With Biliary Atresia After Kasai Procedure. Front Pediatr. 2022;10:837247. https://doi.org/10.3389/fped.2022.837247 DOI: https://doi.org/10.3389/fped.2022.837247

Sun S, Zheng S, Shen C, Dong R, Dong K, Jiang J, et al. Low gamma-glutamyl transpeptidase levels at presentation are associated with severity of liver illness and poor outcome in biliary atresia. Front Pediatr. 2022;10:956732. https://doi.org/10.3389/fped.2022.956732 DOI: https://doi.org/10.3389/fped.2022.956732

Shankar S, Bolia R, Foo HW, D'Arcy CE, Hardikar N, Wensing M, Hardikar W. Normal Gamma Glutamyl Transferase Levels at Presentation Predict Poor Outcome in Biliary Atresia. J Pediatr Gastroenterol Nutr. 2020;70(3):350-5. https://doi.org/10.1097/mpg.0000000000002563 DOI: https://doi.org/10.1097/MPG.0000000000002563

Abdel-Aziz SA, Taha M, Balabel M, Hegazy O, Salah E, Soltan M, et al. Prognostic factors determining the surgical interference of biliary atresia in Egyptian infants: single-center experience. Egyptian Liver Journal. 2023;13(1):38. https://doi.org/10.1186/s43066-023-00254-y DOI: https://doi.org/10.1186/s43066-023-00254-y

Ihn K, Ho IG, Chang EY, Han SJ. Correlation between gamma-glutamyl transpeptidase activity and outcomes after Kasai portoenterostomy for biliary atresia. J Pediatr Surg. 2018;53(3):461-7. https://doi.org/10.1016/j.jpedsurg.2017.10.001 DOI: https://doi.org/10.1016/j.jpedsurg.2017.10.001

Shan W, Shi T, Chen K, Xue J, Wang Y, Yu J, et al. Risk Factors for Severe Community-aquired Pneumonia Among Children Hospitalized With CAP Younger Than 5 Years of Age. Pediatr Infect Dis J. 2019;38(3):224-9. https://doi.org/10.1097/inf.0000000000002098 DOI: https://doi.org/10.1097/INF.0000000000002098

Tekin O, Uraldi C, Işik B, Ozkara A, Ardiçoğlu Y, Erarslan E. Clinical importance of gamma glutamyltransferase in the Ankara-Pursaklar region of Turkey. MedGenMed. 2004;6(1):3

Sun B, Kelleher S, Short C, Arias Valencia P, Zagory JA. Recent advancements in laboratory screening, diagnosis, and prognosis of biliary atresia: a literature review. Digestive Medicine Research. 2021;4 DOI: https://doi.org/10.21037/dmr-21-52

Shen Q, Tan SS, Wang Z, Cai S, Pang W, Peng C, Chen Y. Combination of gamma-glutamyl transferase and liver stiffness measurement for biliary atresia screening at different ages: a retrospective analysis of 282 infants. BMC Pediatr. 2020;20(1):276. https://doi.org/10.1186/s12887-020-02172-z DOI: https://doi.org/10.1186/s12887-020-02172-z

Kunutsor SK. Gamma-glutamyltransferase-friend or foe within? Liver Int. 2016;36(12):1723-34. https://doi.org/10.1111/liv.13221 DOI: https://doi.org/10.1111/liv.13221

Halabi S, Owzar K. The importance of identifying and validating prognostic factors in oncology. Semin Oncol. 2010;37(2):e9-18. https://doi.org/10.1053/j.seminoncol.2010.04.001 DOI: https://doi.org/10.1053/j.seminoncol.2010.04.001

Published

2024-08-31

How to Cite

1.
The Predictive Value of Gamma-Glutamyl Transferase on Jaundice Clearance in Biliary Atresia: An Evidence-Based Case Report and Meta-Analysis. Arch Pediatr Gastr Hepatol Nutr [Internet]. 2024 Aug. 31 [cited 2024 Nov. 21];3(3):20-31. Available from: https://apghn.com/index.php/journal/article/view/70