Background: The clinical course of biliary atresia patients is extremely va
riable. To optimize conservative treatment and correctly schedule liver tra
nsplantation, noninvasive investigations that are predictive of individual
survival and that can be performed regularly an needed. In this study, the
prognostic value of Doppler sonography was investigated in these patients.
Methods: Thirty biliary atresia patients (age range, 1 month to 15.2 years;
mean, 4.0 years) and 38 control subjects underwent standardized Doppler so
nography of liver and spleen. Biochemical rests of liver function and of fi
brogenesis were performed in parallel. Individual clinical outcome was regi
stered 1 and 2 years later.
Results: In control subjects, maximum portal flow velocity (V-max) was more
than 16 cm/sec, and the hepatic vein flow pattern was triphasic. Among chi
ldren with biliary atresia, those with diminished portal V-max a flattened
hepatic vein flow curve, or a hepatic artery resistance index of 0.8 or mor
e had significantly lower indices of hepatic protein synthesis (albumin, ch
olinesterase), higher bilirubin levels, and higher concentrations of marker
s of connective tissue turnover (procollagen peptides, laminin P1) than did
those with normal Doppler sonography measurements. The rate of survival wi
thout transplantation during the following 2 years was significantly lower
in children with abnormal Doppler findings. From portal and hepatic vein fl
ow measurements, patient survival 2 years later could be predicted with an
accuracy of 93%.
Conclusions: In children with extrahepatic biliary atresia, Doppler sonogra
phy of the hepatic blood flow is a noninvasive indicator of disease severit
y, Moreover, it allows a highly accurate prediction of patient survival for
the following 2 years.