Update Course Rewind: MMP-7 & Biliary Atresia Diagnosis 2024

Timely diagnosis of biliary atresia is critical to prolong native liver survival

Cincinnati Children's stopped doing HIDA scans about 25 years ago

HIDA scan adds about 5 days to the diagnostic workup

Doctor Bezarra screened about 1000 proteins in the Children's Network registry and found 70 or so that were elevated in the biliary atresia population, of which MMP-7 was the most clear

MMP-7 is now a validated biomarker for biliary atresia but is not perfect

The sensitivity of MMP-7 is pretty good, but cutoffs vary because the assay is still evolving

At Cincinnati Children's, the commitment is to perform Kasai within 7 days of a biliary atresia patient showing up

A European study showed that performing Kasai before 45 days reduces the incidence of transplant need

Kasai portoenterostomy done before 45 days is the goal

Cincinnati Children's will perform Kasai before 30 days if diagnosis can be established

A direct bilirubin over 1 in the newborn period is very sensitive for biliary atresia