Histological significance of hepatitis‐like findings in biliary atresia: An analysis of 34 Japanese cases

• Published in: Pediatrics international Vol. 61; no. 4; pp. 364 - 368
• Main Authors: Suda, Kazuto, Muraji, Toshihiro, Ohtani, Haruo, Aiyoshi, Tsubasa, Sasaki, Takato, Toma, Miki, Yanai, Toshihiro
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-04-2019
• Subjects: Aspartate aminotransferase; Balloon treatment; Biliary atresia; Bilirubin; Biopsy; Children; graft‐versus‐host disease; Hepatitis; hepatitis‐like findings; Injury analysis; Liver; microchimerism; Neonates; Pediatrics; short‐term prognosis; hepatitis-like findings; biliary atresia; microchimerism; short-term prognosis; graft-versus-host disease
• ISSN: 1328-8067; 1442-200X
• DOI: 10.1111/ped.13816

Background
Hepatocellular injury including multinuclear changes are common histological features in biliary atresia (BA), as well as in neonatal hepatitis. To date, however, no reports have examined how those findings correlate with the prognosis of BA. We clarified the clinical implications of hepatitis‐related changes in BA on histological analysis.
Methods
We retrospectively reviewed 34 cases of BA treated over the past 30 years at Ibaraki Children's Hospital. Liver biopsy specimens during Kasai procedures were evaluated for hepatocyte multinuclear change, ballooning, and acidophilic body, hereby defined as hepatitis‐like findings (HLF). Each finding was semi‐quantitatively scored as 0–2, and their sum was defined as the HLF score, ranging from 0 to 6. We examined the correlation between HLF score and total bilirubin (T‐Bil), direct bilirubin (D‐Bil), and other liver function test results at the Kasai procedure, as well as 1 week, and 1, 3, and 6 months after the Kasai procedure. Subsequently, HLF score was compared between native liver survivors (NLS; n = 16) and non‐NLS (n = 18) for long‐term analyses.
Results
Hepatitis‐like findings score except for aspartate aminotransferase (AST), had no correlation with the preoperative data. HLF score was positively correlated, however, with T‐Bil, D‐Bil, and AST at 1 week and 1 month after the Kasai procedure (1 week: P = 0.009, 0.023, and 0.019; 1 month: 0.022, 0.019, and 0.013, respectively). HLF score was not significantly different between the NLS and non‐NLS groups.
Conclusion
Higher HLF score at Kasai procedure is an indicator of poor liver function at short‐term follow up.