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Risk of variceal hemorrhage and pretransplant mortality in children with biliary atresia

dc.contributor.authorBass, Lee M.
dc.contributor.authorYe, Wen
dc.contributor.authorHawthorne, Kieran
dc.contributor.authorLeung, Daniel H.
dc.contributor.authorMurray, Karen F.
dc.contributor.authorMolleston, Jean P.
dc.contributor.authorRomero, Rene
dc.contributor.authorKarpen, Saul
dc.contributor.authorRosenthal, Philip
dc.contributor.authorLoomes, Kathleen M.
dc.contributor.authorWang, Kasper S.
dc.contributor.authorSquires, Robert H.
dc.contributor.authorMiethke, Alexander
dc.contributor.authorNg, Vicky L.
dc.contributor.authorHorslen, Simon
dc.contributor.authorKyle Jensen, M.
dc.contributor.authorSokol, Ronald J.
dc.contributor.authorMagee, John C.
dc.contributor.authorShneider, Benjamin L.
dc.contributor.authorAlonso, Estella
dc.date.accessioned2022-09-26T16:01:12Z
dc.date.available2023-10-26 12:01:10en
dc.date.available2022-09-26T16:01:12Z
dc.date.issued2022-09
dc.identifier.citationBass, Lee M.; Ye, Wen; Hawthorne, Kieran; Leung, Daniel H.; Murray, Karen F.; Molleston, Jean P.; Romero, Rene; Karpen, Saul; Rosenthal, Philip; Loomes, Kathleen M.; Wang, Kasper S.; Squires, Robert H.; Miethke, Alexander; Ng, Vicky L.; Horslen, Simon; Kyle Jensen, M.; Sokol, Ronald J.; Magee, John C.; Shneider, Benjamin L.; Alonso, Estella (2022). "Risk of variceal hemorrhage and pretransplant mortality in children with biliary atresia." Hepatology (3): 712-726.
dc.identifier.issn0270-9139
dc.identifier.issn1527-3350
dc.identifier.urihttps://hdl.handle.net/2027.42/174758
dc.description.abstractBackground and AimsThe natural history of gastroesophageal variceal hemorrhage (VH) in biliary atresia (BA) is not well characterized. We analyzed risk factors, incidence, and outcomes of VH in a longitudinal multicenter study.Approach and ResultsParticipants enrolled in either an incident (Prospective Database of Infants with Cholestasis [PROBE]) or prevalent (Biliary Atresia Study of Infants and Children [BASIC]) cohort of BA were included. Variceal hemorrhage (VH) was defined based on gastrointestinal bleeding in the presence of varices accompanied by endoscopic or nontransplant surgical intervention. Cumulative incidence of VH and transplant‐free survival was compared based on features of portal hypertension (e.g., splenomegaly, thrombocytopenia) and clinical parameters at baseline in each cohort (PROBE: 1.5 to 4.5 months after hepatoportoenterostomy [HPE]; BASIC: at enrollment > 3 years of age). Analyses were conducted on 869 children with BA enrolled between June 2004 and December 2020 (521 in PROBE [262 (51%) with a functioning HPE] and 348 in BASIC). The overall incidence of first observed VH at 5 years was 9.4% (95% CI: 7.0–12.4) in PROBE and 8.0% (5.2–11.5) in BASIC. Features of portal hypertension, platelet count, total bilirubin, aspartate aminotransferase (AST), albumin, and AST‐to‐platelet ratio index at baseline were associated with an increased risk of subsequent VH in both cohorts. Transplant‐free survival at 5 years was 45.1% (40.5–49.6) in PROBE and 79.2% (74.1–83.4) in BASIC. Two (2.5%) of 80 participants who had VH died, whereas 10 (12.5%) underwent transplant within 6 weeks of VH.ConclusionsThe low risk of VH and associated mortality in children with BA needs to be considered in decisions related to screening for varices and primary prophylaxis of VH.
dc.publisherWiley Periodicals, Inc.
dc.titleRisk of variceal hemorrhage and pretransplant mortality in children with biliary atresia
dc.typeArticle
dc.rights.robotsIndexNoFollow
dc.subject.hlbsecondlevelInternal Medicine and Specialties
dc.subject.hlbtoplevelHealth Sciences
dc.description.peerreviewedPeer Reviewed
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/174758/1/hep32451_am.pdf
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/174758/2/hep32451.pdf
dc.identifier.doi10.1002/hep.32451
dc.identifier.sourceHepatology
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dc.working.doiNOen
dc.owningcollnameInterdisciplinary and Peer-Reviewed


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