Using ^99m Tc-DTPA galactosyl human serum albumin liver scintigraphy as a prognostic indicator in jaundice-free patients with biliary atresia

Background: We evaluated the clinical significance of follow-up data, including ^99m Tc-DTPA galactosyl human serum albumin ( ^99m Tc-GSA) liver scintigraphy data, as prognostic indicators for jaundice-free patients with biliary atresia (BA). Methods: Of 87 patients who underwent Kasai portoenterostomy (KP) between 1991 and 2012, 45 jaundice-free patients aged 1–2 years underwent ^99m Tc-GSA scintigraphy and were classified into 2 groups: those who survived with a native liver (Group A, n = 34) and those who required liver transplantation (LTx) (Group B, n = 11). We compared ^99m Tc-GSA scintigraphy data (HH15, LHL15, and HH15/LHL15 [H/L15]) and liver function test (LFT) results between the groups. The patients underwent a second ^99m Tc-GSA scintigraphy at approximately 5 years of age. Results: All patients survived. HH15, H/L15, total bilirubin, direct bilirubin, gamma-glutamyl transpeptidase, and alanine transaminase levels were higher in Group B than in Group A (p < 0.05). Total and direct bilirubin levels were associated with H/L15 (p < 0.05). There were no significant changes in results between the first and second ^99m Tc-GSA scintigraphy in Group A. Conclusions: Mid- and long-term prognoses may be predicted using ^99m Tc-GSA scintigraphy data and LFTs in patients aged 1–2 years. We recommend regular monitoring of postoperative data following KP, even in jaundice-free patients. Level of evidence: III.