Assessing Native Liver Post-Kasai Portoenterostomy for Biliary Atresia Through Stool Proteome Analysis

BACKGROUND AND AIMS: Biliary atresia (BA) is a severe neonatal condition, characterized by jaundice and hyperbilirubinemia, resulting in cholestasis. Although early diagnosis followed by Kasai portoenterostomy (KPE) can rescue patients, they are prone to complications such as cholangitis. Moreover, a comprehensive study assessing intestinal environment is currently lacking. Therefore, in this study, we aimed to elucidate the stool protein profiles of patients with BA following KPE, provide insights into the native liver condition of BA, and open new avenues for clinical approaches through stool proteome analysis. METHODS: In this prospective study, stool proteome analysis was conducted on samples from 4 patients with well-controlled conditions, 4 patients with repeated cholangitis, and 3 patients with prolonged jaundice without cholangitis, all of whom had undergone KPE. Fifteen healthy individuals without BA were included for comparison. RESULTS: Principal component analysis revealed that the stool profiles of patients post-KPE with favorable outcomes closely resembled those of healthy controls, whereas the profiles of patients with unfavorable outcomes showed distinct patterns. Notably, C-reactive protein levels were elevated, whereas sodium/hydrogen exchanger 3 levels were decreased in the group with repeated cholangitis. CONCLUSION: This study highlights distinct differences in stool protein profiles following KPE, particularly in patients with poor clinical outcomes. This suggests that stool proteome analysis has the potential to provide insights into the native liver conditions of BA patients post-KPE, reflecting their clinical status.