Significance of ductal plate malformation in the postoperative clinical course of biliary atresia.
OBJECTIVE
Ductal plate malformation (DPM) is one of the etiologic theories for the development of biliary atresia (BA). In this study, we investigated the significance of DPM in the postoperative clinical course of BA, especially as a predictive factor of jaundice clearance.


METHODS
Between 1988 and 2005, 31 patients with uncorrectable BA underwent hepatoportoenterostomy and steroid therapy. Immunohistochemistry was used to characterize biliary structures using cytokeratin 19. Specimens were defined as DPM-positive if a concentric cellular arrangement was detected. This retrospective study included comparisons of preoperative characteristics, the postoperative jaundice period, and cumulative steroid doses between patients with and without DPM.


RESULTS
Of the 31 patients with uncorrectable BA, 25 (80.6%) became jaundice-free. Ductal plate malformation was detected in 11 (35.5%) of the 31. Between the 2 groups, there were no differences in preoperative characteristics or in the postoperative jaundice-free rate. Among those who became anicteric, the postoperative jaundice period was 145.3 +/- 69.9 days in the DPM-positive group (n = 9) and 81.8 +/- 44.7 days in the DPM-negative group (n = 16) (P < .05). The total administered steroids were 149.7 +/- 78.2 and 95.0 +/- 60.2 mg/kg, respectively (P = .09).


CONCLUSIONS
Ductal plate malformation may disturb bile flow and require more steroid to improve bile drainage. Therefore, the presence of DPM in the liver predicts poor bile flow after hepatoportoenterostomy in infants with BA.
Shimadera
Shinichi
S
Division of Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan. sshima@koto.kpu-m.ac.jp
Iwai
Naomi
N
Deguchi
Eiichi
E
Kimura
Osamu
O
Ono
Shigeru
S
Fumino
Shigehisa
S
Higuchi
Koji
K
D001652:Bile Ducts / Q000002:abnormalities*; D001653:Bile Ducts, Intrahepatic / Q000002:abnormalities; D001656:Biliary Atresia / Q000473:pathology* / Q000601:surgery*; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
D013256:Steroids