Biliary atresia liver histopathological determinants of early post-Kasai outcome

Background: A retrospective chart review of liver histologies in Kasai biliary atresia BA patients operated 1/2017- 7/2019 at our institution was conducted to identify histologic prognostic factors for biliary outcome. Methods: Patients with wedge liver biopsies and portal plate biopsies (n = 85) were categorized into unfavorable and favorable outcome, based on a 3-month serum total bilirubin level of <34 mu M or mortality. Hepatocellular histologies, presence of ductal plate malformation (DPM) and of large bile duct of >= 150 mu m diameter size at the portal plate were evaluated. Results: Total Bilirubin levels> 34 mu M correlates with worse 1-year survival. Age at surgery, histologic fibrosis or inflammation does not predict outcome. Potential adverse predictors are severe hepatocellular swelling, severe cholestasis, presence of DPM (n = 24), and portal plate bile duct size < 150 mu m (n = 28). In multivariate analyses adjusting for age at Kasai and postop cholangitis, bile duct size and severe hepatocellular swelling remain independent histologic prognosticators (OR 3.25, p = 0.039 and OR 3.26, p = 0.006 respectively), but not DPM. Conclusion: Advanced histologic findings of portal plate bile duct size of <150 mu m and severe hepatocellular damage predict poor post-Kasai jaundice clearance and short-term survival outcome, irrespective of Kasai timing. Published by Elsevier Inc.

Automated summary

The study identified advanced histologic findings of portal plate bile duct size <150μm and severe hepatocellular damage as predictors of poor post-Kasai jaundice clearance and short-term survival outcomes.