• Hirofumi Tomita, Naoki Shimojima, Hideyuki Sasaki, Akihiro Shimotakahara, Yohei Yamada, Tatsuo Kuroda, Masaki Nio, and Seiichi Hirobe.
• Department of Surgery, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
• Ann. Surg. 2024 Apr 1; 279 (4): 692698692-698.

ObjectiveTo identify patients with biliary atresia (BA) with extremely poor outcomes of bile drainage surgery using the infant BA liver fibrosis (iBALF) score, a liver fibrosis marker based on standard blood analysis.BackgroundAlthough primary liver transplantation is beginning to be considered as an alternative to bile drainage surgery in patients with BA, those most likely to benefit from this procedure have not yet been identified.MethodsThe medical records of 380 patients with BA with bile drainage surgery between 2015 and 2019 were collected for retrospective analysis from 60 participating hospitals. To predict native liver survival at age 1 year, a receiver operating characteristic curve was drawn for the iBALF score. The cutoff value was determined as the point indicating >99% sensitivity.ResultsThe median age at surgery was 56 days (range: 4-183 days), and native liver survival at age 1 year was achieved in 258 (67.9%) patients. An iBALF score of 5.27 was chosen as the cutoff, and 18 patients (4.7%) were found to have an iBALF score >5.27; of these, only 2 (95% CI: 1.4%-34.7%) had native liver survival at age 1 year, indicating a significantly poorer outcome than in the other patients (95% CI: 65.7%-75.4%). Moreover, patients with an iBALF score >5.27 had significantly higher mortality and younger age at salvage liver transplantation.ConclusionsPatients with BA having a preoperative iBALF score >5.27 had extremely poor outcomes of bile drainage surgery and may be considered candidates for primary LTx.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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