Correlation of Pre- and Post-operative Liver Function, Duct Diameter at Porta Hepatis, and Portal Fibrosis with Surgical Outcomes in Biliary Atresia

Overview

Journal J Indian Assoc Pediatr Surg

Specialty Pediatrics

Date 2015 Dec 3

PMID 26628810

Citations 7

Authors

Rajib Ray Baruah

Veereshwar Bhatnagar

Sandeep Agarwala

Siddhartha Datta Gupta

Affiliations

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Abstract

Background And Aims: Extrahepatic biliary atresia is one of the most challenging conditions in pediatric surgery. The definition of prognostic factors is controversial. Surgical outcomes after bilioenteric drainage procedures are variable. This study attempts to correlate the pre- and post-operative liver histology with clinical factors in order to define early predictors of success.

Materials And Methods: Twenty consecutive patients, treated by Kasai's portoenterostomy (KP) over a 3 years period were included in this study. Tissue obtained from the porta hepatis was analyzed for duct size using an optical micrometer and was categorized into three types: I-No demonstrable ducts; II - <50 μ; III - >50 μ. Pre- and post-operative liver biopsy was analyzed for architectural changes and fibrosis; hepatic fibrosis was quantified using existing criteria. Pre- and post-operative liver function tests (LFTs) were also done. Surgical outcomes were defined as: (A) Disappearance of jaundice within 3 months; (B) initial disappearance of jaundice with recurrence by 6 months and (C) persistence of jaundice. Duct diameters, fibrosis score, and LFT were correlated with age and clinical outcomes.

Results: The surgical outcomes were: A-6 patients (30%), B-6 patients (30%), C-8 patients (40%). The duct size at the porta was I-3 patients, II-11 patients, and III-4 patients (tissue was not available in 2 cases). The change in total serum bilirubin (mg%) from pre- to post-operative period was 13.6 ± 3.9 (Group A), 4.6 ± 2.8 (Group B), and 3.4 ± 3.9 (group C) (P < 0.001) and direct and indirect fractions followed a similar trend; the changes in liver enzymes were not significant. The changes in hepatic histopathological changes (ballooning of hepatocytes, giant cells, cholestasis, portal tract infiltration, ductular proliferation, lobular necrosis, and fibrosis) were also not significant but there was a definite trend in the change in fibrosis -1.500 ± 1.643 (Group A), 0.667 ± 2.582 (Group B), and 1.500 ± 1.852 (Group C) - reduction of fibrosis with good results and progression of fibrosis with poor results.

Conclusions: Following KP, jaundice persisted in 40% patients; it disappeared in 60% patients but reappeared in half of these patients 6 months postoperatively. The duct size at the porta hepatis did not correlate with age or surgical outcome. Serum bilirubin showed the best correlation with surgical outcome. Postoperative changes in hepatic fibrosis seem to have some bearing on surgical outcomes-progressive fibrosis is a poor prognostic factor.

Citing Articles

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Predictors of Successful Kasai Portoenterostomy and Survival with Native Liver at 2 Years in Infants with Biliary Atresia.

Kumar R, Lal B, Sood V, Khanna R, Kumar S, Bharathy K J Clin Exp Hepatol. 2019; 9(4):453-459.

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Ratio of Preoperative and Postoperative Serum Bilirubin Levels Predicts Early Outcome Following Biliary Atresia Surgery.

Khanna K, Bhatnagar V, Agarwala S, Srinivas M, Gupta S J Indian Assoc Pediatr Surg. 2018; 23(2):81-86.

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Sun S, Zheng S, Lu X, Chen G, Ma Y, Chen L Pediatr Surg Int. 2018; 34(4):381-386.

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References

ISHAK K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F . Histological grading and staging of chronic hepatitis. J Hepatol. 1995; 22(6):696-9. DOI: 10.1016/0168-8278(95)80226-6. View

Gautier M, Jehan P, Odievre M . Histologic study of biliary fibrous remnants in 48 cases of extrahepatic biliary atresia: correlation with postoperative bile flow restoration. J Pediatr. 1976; 89(5):704-9. DOI: 10.1016/s0022-3476(76)80787-1. View

Karrer F, Lilly J, Stewart B, Hall R . Biliary atresia registry, 1976 to 1989. J Pediatr Surg. 1990; 25(10):1076-80; discussion 1081. DOI: 10.1016/0022-3468(90)90222-u. View

Kang N, Davenport M, DRIVER M, Howard E . Hepatic histology and the development of esophageal varices in biliary atresia. J Pediatr Surg. 1993; 28(1):63-6. DOI: 10.1016/s0022-3468(05)80357-4. View

Chandra R, Altman R . Ductal remnants in extrahepatic biliary atresia: A histopathologic study with clinical correlation. J Pediatr. 1978; 93(2):196-200. DOI: 10.1016/s0022-3476(78)80495-8. View

Kasai M, Watanabe I, Ohi R . Follow-up studies of long term survivors after hepatic portoenterostomy for "noncorrectible" biliary atresia. J Pediatr Surg. 1975; 10(2):173-82. DOI: 10.1016/0022-3468(75)90275-4. View

Tan C, Davenport M, DRIVER M, Howard E . Does the morphology of the extrahepatic biliary remnants in biliary atresia influence survival? A review of 205 cases. J Pediatr Surg. 1994; 29(11):1459-64. DOI: 10.1016/0022-3468(94)90144-9. View

Lawrence D, Howard E, Tzannatos C, Mowat A . Hepatic portoenterostomy for biliary atresia. A comparative study of histology and prognosis after surgery. Arch Dis Child. 1981; 56(6):460-3. PMC: 1627475. DOI: 10.1136/adc.56.6.460. View

Miyano T, Suruga K, Tsuchiya H, Suda K . A histopathological study of the remnant of extrahepatic bile duct in so-called uncorrectable biliary atresia. J Pediatr Surg. 1977; 12(1):19-25. DOI: 10.1016/0022-3468(77)90291-3. View

10.

Tagge D, Tagge E, Drongowski R, Oldham K, Coran A . A long-term experience with biliary atresia. Reassessment of prognostic factors. Ann Surg. 1991; 214(5):590-8. PMC: 1358615. DOI: 10.1097/00000658-199111000-00009. View

11.

Kasai M . Treatment of biliary atresia with special reference to hepatic porto-enterostomy and its modifications. Prog Pediatr Surg. 1974; 6:5-52. View

12.

Vazquez-Estevez J, Stewart B, Shikes R, Hall R, Lilly J . Biliary atresia: early determination of prognosis. J Pediatr Surg. 1989; 24(1):48-50; discussion 50-1. DOI: 10.1016/s0022-3468(89)80300-8. View

13.

Suruga K, Miyano T, Arai T, Ogawa T, Sasaki K, Deguchi E . A study of patients with long-term bile flow after hepatic portoenterostomy for biliary atresia. J Pediatr Surg. 1985; 20(3):252-5. DOI: 10.1016/s0022-3468(85)80115-9. View