The extent of biliary proliferation in liver biopsies from patients with biliary atresia at portoenterostomy is associated with the postoperative prognosis.
OBJECTIVE
In biliary atresia (BA), a derangement in the biliary system remains, despite portoenterostomy performance. Many factors can influence the disease progression rate. This study aimed to analyze the association between biliary proliferation extent in biopsies from BA patients and postoperative prognosis.


METHODS
Biliary proliferation was evaluated by a morphometric analysis of the cytokeratin 7 positivity percentage (PCK7) in wedge liver biopsies from 47 BA patients. The extent of fibrosis was evaluated by a fibrosis score (FS). The outcome 1-year native liver survival was correlated, using a multivariable regression analysis, with PCK7, FS, and age at portoenterostomy.


RESULTS
The PCK7 ranged between 0.80% and 14.79% (M +/- SD = 7.36% +/- 4.15%). Patients who died or underwent transplantation had higher PCK7 than survivors with their native livers (P < .001). The area under the receiver operating characteristic curve for PCK7 in relation to the outcome was 0.845 (P < .001). The cutoff point of PCK7 for the maximal effect on postoperative prognosis was 10.18% (sensitivity = 0.71, specificity = 0.88). The PCK7 was the only studied variable associated with 1-year native liver survival, independently of age and FS (P = .002).


CONCLUSIONS
The extent of biliary proliferation at portoenterostomy, evaluated by PCK7, was associated with 1-year native liver survival of BA patients.
Hospital de Clínicas de Porto Alegre, CEP-90035-903, Brazil. kapars@terra.com.br
Jorge L
JL
Santos
Carlos O
CO
Kieling
Luise
L
Meurer
Sandra
S
Vieira
Cristina T
CT
Ferreira
Andrea
A
Lorentz
Themis R
TR
Silveira
D001656:Biliary Atresia / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D001707:Biopsy, Needle; D049109:Cell Proliferation; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D022781:Hepatocytes / Q000166:cytology / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053552:Keratin-7 / Q000032:analysis / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D008115:Liver Regeneration / Q000502:physiology*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013997:Time Factors
D015415:Biomarkers; D053552:Keratin-7