Clinical data
A total of 65 children diagnosed with BA were enrolled in this study, including 29 males and 36 females, with a median operation age of 60 days (50.75-70d). Among these children, 8 did not undergo the Kasai procedure. Serum samples were collected from 57 patients before surgery. Fifty-five samples (96.49%) were collected three months after the Kasai procedure until November 1, 2021; 15 postoperatively from infants without vitamin D supplementation (non-Vitamin D supplementation Group, non-VDS) and 40 from infants with regular vitamin D supplementation (Vitamin D supplementation Group, VDS). At 6 and 12 months after the Kasai procedure, data were collected from 28 and 26 children with native liver and regular vitamin D supplementation, respectively. During the follow-up period, no children suffered from rickets or vitamin D poisoning, and the survival time of native liver was < 1 year in 9 cases.
Serum Vitamin D level in different periods before and after Kasai procedure
All the children were with vitamin D deficiency or insufficiency, where 31.58% were with vitamin D insufficiency, and 68.42% were vitamin D deficient (Table 1). Although there was no significant difference in the preoperative level of 25(OH) VD between the 15 children in the non-VDS group and the 40 children in the VDS group 3 months after surgery (t=-0.327, P=0.745, Table 2), the level of 25(OH) VD in the non-VDS group was significantly lower than that in the VDS group at 3 months after surgery (t=-2.974, P=0.004, Table 2). Among the 40 children who lived with the native liver at 3, 6, and 12 months after the Kasai procedure with regular oral vitamin D supplementation, 38.18%, 75%, and 92.31% were in vitamin D sufficiency status, respectively (Table 1). The level of 25(OH)VD at different periods before and after Kasai procedure significantly differed (F=50.802, P=0.000, Figure 1).
Table 1. Vitamin D status in children with regular vitamin D supplementation before and after Kasai procedure
|
cases
|
Gender
|
Serum vitamin D level
|
male
|
female
|
x̅±SD (nmol/L)
|
Sufficiency
(%)
|
Insufficiency
(%)
|
deficiency
(%)
|
preoperative
|
57
|
27
|
30
|
27.01±9.14
|
0
|
18 (31.58)
|
39 (68.42)
|
3 months after surgery
|
40
|
21
|
19
|
55.73±27.64*
|
19 (38.18)
|
13 (36.36)
|
8 (25.45)
|
6 months after surgery
|
28
|
15
|
13
|
98.86±53.29
|
21 (75.00)
|
4 (14.29)
|
3 (10.71)
|
12 months after surgery
|
26
|
13
|
13
|
115.06±50.92
|
24 (92.31)
|
1 (3.85)
|
1 (3.85)
|
Table 2. Vitamin D status and liver fibrosis degree of patients with vitamin D supplementation 3 months after Kasai procedure
|
Cases
|
Gender
|
25(OH)VD level
|
APRI
|
male
|
female
|
Before surgery
|
3 months after surgery
|
Before surgery
|
3 months after surgery
|
non-VDS
|
15
|
6
|
9
|
26.52±7.94
|
32.92±17.37
|
1.57±0.81
|
1.24±0.55
|
VDS
|
40
|
21
|
19
|
27.44±9.70
|
55.73±27.64*
|
1.60±1.25
|
0.93±0.59**
|
Note: * indicates that the serum 25(OH)VD level in the VDS group was significantly higher than the non-VDS group (t=-2.974, P=0.004). ** indicates that the degree of liver fibrosis in the VDS group was less than the non-VDS group, but the difference was not statistically significant (t=1.787, P=0.08).
There was no significant correlation between serum 25(OH)VD level and ALT, AST, γGT, ALP, TB, DB, TBA preoperatively (P>0.05, Table 3). The serum 25(OH)VD level was not significantly correlated with APRI value (r=-0.183,P=0.173).
Table 3. Association between 25(OH) VD level, liver function, and liver fibrosis indicators before and after Kasai procedure
|
Preoperative
|
Postoperative
|
|
M(Q25-Q75)
|
R
|
P
|
M(Q25-Q75)
|
R
|
P
|
ALT(U/L)
|
163(107.58~225.23)
|
-0.261
|
0.050
|
77.25(48.73~142.23)
|
-0.234
|
0.023
|
AST(U/L)
|
246.50(159.50~323.18)
|
-0.191
|
0.155
|
106.80(61.00~191.98)
|
-0.406
|
0.000
|
γGT(U/L)
|
419.00(181.75~810.00)
|
0.166
|
0.216
|
497.00(248.25~738.25)
|
-0.425
|
0.000
|
ALP(U/L)
|
559.00(436.00~765.00)
|
-0.251
|
0.059
|
268.25(141.75~268.25)
|
-0.465
|
0.000
|
TBA
|
121.90(94.13~121.90)
|
0.144
|
0.290
|
39.90(13.20~101.98)
|
-0.619
|
0.000
|
TB(μmol/L)
|
190.80(157.65~262.73)
|
-0.216
|
0.106
|
12.45(5.00~38.18)
|
-0.697
|
0.000
|
DB(μmol/L)
|
116.85(94.93~147.35)
|
-0.133
|
0.324
|
22.95(4.88~61.43)
|
-0.258
|
0.012
|
Association of vitamin D level with liver function and liver fibrosis after Kasai procedure
In infants with native liver and regular vitamin D supplementation after surgery, the level of 25(OH)VD was negatively correlated with ALT, AST, γGT, TB, DB, and TBA (Table 3), and was negatively correlated with APRI (R2=0.072, P=0.009, Figure 2). There were statistically significant differences in the degree of liver fibrosis at different periods before and after the Kasai procedure (F=5.033, P=0.002). In infants living with native liver, APRI at 3 and 6 months after surgery was lower than that before surgery. The APRI level 12 months after surgery was lower than before, but the difference was not statistically significant (Figure 3). The degree of preoperative liver fibrosis in the non-VDS group was not significantly different from that in the VDS group (t=-0.069, P=0.945), and APRI was slightly higher compared to the VDS group at 3 months after surgery; however, the difference was not statistically significant (T =1.787, P=0.08, Table 2).