Comparison of preoperative serum MMP-7 to liver two-dimensional shear wave elastography and its integration into a novel nomogram for predicting the native liver survival of infants with biliary atresia

Sep 30, 2026

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Biliary atresia is a rare, severe pediatric cholangiopathy where accurate outcome prediction after Kasai portoenterostomy (KPE) is essential for individualized management. This prospective cohort study compared preoperative serum matrix metalloproteinase-7 (MMP-7) with liver two-dimensional shear wave elastography (2D-SWE) and other laboratory biomarkers for forecasting native liver survival (NLS) beyond two years. Findings showed strong diagnostic discrimination for MMP-7 and identified independent NLS risk factors, enabling an MMP-7–based nomogram and postoperative risk stratification for prognosis optimization.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

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Background

Methods

Results

Conclusions

Introduction

Original Article Comparison of preoperative serum MMP-7 to liver twodimensional shear wave elastography and its integration into a novel nomogram for predicting the native liver survival of infants with biliary atresia Hualin Yan1\#^, Yimao Zhang2\#, Siyu Pu2, Yifan Deng2, Xiangfeng Zeng1, Juxian Liu1^, Shuguang Jin2 1Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, China; 2Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China Contributions: (I) Conception and design: H Yan, Y Zhang, J Liu, S Jin; (II) Administrative support: J Liu, S Jin; (III) Provision of study materials or patients: H Yan, S Pu, Y Deng; (IV) Collection and assembly of data: S Pu, Y Deng, X Zeng; (V) Data analysis and interpretation: Y Zhang, S Pu, X Zeng; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. \#These authors contributed equally to this work. Correspondence to: Juxian Liu, MD. Department of Medical Ultrasound, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China. Email: [liujuxian@wchscu.cn](liujuxian@wchscu.cn); Shuguang Jin, MD, PhD. Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China. Email: [shgjin2003@aliyun.com](shgjin2003@aliyun.com). Background: Biliary atresia (BA) is a rare and severe cholangiopathy. Accurate prediction of outcomes following Kasai portoenterostomy (KPE) is crucial for guiding individualized treatment strategies. This study primarily aimed to investigate the prognostic value of various laboratory biomarkers, including preoperative serum matrix metalloproteinase-7 (MMP-7) level. Methods: This prospective cohort study included consecutive infants with conjugated hyperbilirubinemia who were evaluated with serum MMP-7, liver two-dimensional shear wave elastography (2D-SWE), and other laboratory tests from July 2020 to September 2024. The reference standard for diagnosis was intraoperative cholangiography. We recorded the follow-up of native liver survival (NLS) time post-KPE longer than 2 years. Area under the curve (AUC) analysis, Kaplan-Meier survival analysis, Cox regression analyses, and establishment of an NLS nomogram were performed. Results: A total of 154 patients (median age 66 days), including 83 BA infants and 71 non-BA cholestatic infants, were included in the study. Serum MMP-7 distinguished infants with BA from other cholestatic infants, with a high diagnostic AUC of 0.95 [95% confidence interval (CI): 0.91–0.99] . Multivariate Cox regression analysis identified serum MMP-7 [hazard ratio (HR) 3.31], serum γ-glutamyltransferase (GGT) (HR 3.81), age at surgery (HR 2.21), and liver 2D-SWE (HR 11.47) as independent risk factors for NLS. An NLS nomogram based on the serum MMP-7, serum GGT, and age at surgery achieved a concordance index of 0.76 (95% CI: 0.67–0.85) . A risk score was also established to stratify high-risk and low-risk patients post-KPE. Conclusions: The preoperative serum MMP-7 is valuable for predicting post-KPE prognosis. The novel nomogram and risk score effectively predict NLS following KPE, offering critical and practical guidance for optimizing BA treatment strategies. ^ ORCID: Hualin Yan, 0000-0003-1338-1124; Juxian Liu, 0000-0002-5315-5482. © AME Publishing Company. Quant Imaging Med Surg 2026;16(1):42 | [https://dx.doi.org/10.21037/qims-2025-872](https://dx.doi.org/10.21037/qims-2025-872) Page 2 of 12 Yan et al. MMP-7 is comparable to liver SWE and can predict NLS of BA Keywords: Biliary atresia (BA); matrix metalloproteinase-7 (MMP-7); shear wave elastography (SWE); native liver survival (NLS); nomogram Submitted Apr 11, 2025. Accepted for publication Oct 28, 2025. Published online Dec 31, 2025. doi: 10.21037/qims-2025-872 View this article at: [https://dx.doi.org/10.21037/qims-2025-872](https://dx.doi.org/10.21037/qims-2025-872) Introductio

FAQs

What is the main goal of this study in biliary atresia patients after KPE?

To evaluate the prognostic value of preoperative serum biomarkers, particularly serum MMP-7, and compare them with liver 2D-SWE for predicting native liver survival after KPE.

Which preoperative measures were compared as predictors of native liver survival?

Serum MMP-7, liver two-dimensional shear wave elastography (2D-SWE), and other laboratory tests.

How did the study build its predictive model and how can it be used?

It established an NLS nomogram based on serum MMP-7, serum GGT, and age at surgery, and derived a risk score to stratify patients into high- and low-risk groups after KPE.

Sep 30, 2026

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