Biliary atresia (BA) is a cholangiopathy characterised by bile flow blockage caused by biliary tree damage. BA results in mortality or liver transplant if not surgically corrected with a Kasai portoenterostomy (KPE) (LTx). BA is distinguished by early-onset, progressive liver fibrosis. Collagen hybridising peptide (CHP) is a synthetic peptide that binds to denatured collagen strands and allows fibrosis to be quantified. Human liver tissue has not been subjected to this method. The purpose of this pilot research was to assess the usefulness of CHP as a quantitative fibrosis assessment to allow for early survival with native liver prognostication. We found 21 patients with accessible wedge liver samples, 14 of whom required LTx. There were no fatalities. At 3 months post-KPE, patients requiring LTx tended to be females with substantially differing mean bilirubin, albumin, and alanine aminotransferase levels. By one year after KPE, 50% of patients in the high CHP intensity group needed LTx, compared to 27% in the low CHP group. Overall, fibrosis as measured by CHP at the time of KPE was linked with a more than threefold increase in the probability of needing LTx by 4 years of age. It predicted approximately 7 times the risk of LTx after adjusting for sex, total bilirubin >2 mg/dL, and albumin at 3 months post-KPE.

The findings indicate that quantitative fibrosis evaluation at the time of KPE offers promise as an early predictor of LTx need in BA. A bigger research to evaluate quantitative fibrosis as a BA prognostic tool is warranted.