With invasive liver biopsy as the current guideline for detecting Fontan-associated liver disease (FALD), physician-scientists at Riley Children’s Health have identified non-invasive biomarkers for diagnosing liver disease in Fontan patients.
“This study demonstrated that FIB-4 (Fibrosis-4) and APRI (AST-to-platelet ratio index) markers, which are inexpensive routine labs, and FibroScan can be used to monitor liver disease in Fontan patients,” said Chaowapong Jarasvaraparn, MD, pediatric gastroenterologist at Riley Children’s, and assistant professor of clinical pediatrics at Indiana University School of Medicine. “So far, our research shows that liver biopsy may not be needed for all Fontan patients if these markers are within the normal limits."
The study, “Biomarkers of Fibrosis and Portal Hypertension of Fontan-Associated Liver Disease in Children and Adults,” was named best abstract at the 2023 International Fontan Kreutzer Symposium. The retrospective cohort study included 66 Fontan patients, older than 10 years, who had a liver biopsy at Riley Children’s. Specifically, the study investigated the correlation of biomarkers with severity of fibrosis on liver biopsy and measures of portal hypertension in children and adults with FALD.
“With further study, if we are able to validate the use of FIB-4 and APRI markers to assess and monitor liver disease progression, it will be a significant development in safety for Fontan patients, who are at high risk of bleeding after liver biopsy,” Dr. Jarasvaraparn said.
In addition to Dr. Jarasvaraparn as principal investigator, the research team at Riley Children’s includes cardiologists Jessica Thoe, MD, Andrew Rodenbarger, MD, Ronald M. Payne, MD, and Larry W. Markham, MD, and Riley gastroenterologist Jean P. Molleston, MD.
The findings of this study are currently under review for publication. Based on the initial study results, the research team at Riley Children’s is leading a prospective multicenter study to develop prognostic biomarkers to determine which patients need liver biopsy. At this time, eight centers are involved in this phase of the research.
Through a comprehensive Pediatric Liver Program, specialists with Riley Gastroenterology, Hepatology and Nutrition provide expert diagnosis and management of children with a variety of liver diseases. In addition, Riley Children’s is home to leading multidisciplinary programs for intestinal rehabilitation, eosinophilic disorders, inflammatory bowel disease, motility and aerodigestive disorders, and weight management.
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Primary Investigator
Dr. Chaowapong Jarasvaraparn specializes in Pediatric Gastroenterology for Riley Pediatric Gastroenterology, Hepatology & Nutrition. Dr. Jarasvaraparn earned his medical degree at Mahidol University. He then completed a residency at the University of South Alabama Children's and Women's Hospital University of South Alabama and a fellowship at St. Louis Children's Hospital Washington University School of Medicine.