Predicting factors on the occurrence of cystic dilatation of intrahepatic biliary system in biliary atresia.
OBJECTIVE
Cystic dilatation of intrahepatic biliary system (CDIB) is an intractable complication of biliary atresia (BA). In this study, we investigated the predicting factors of CDIB development after jaundice resolved following hepatoportoenterostomy (HPE).


METHODS
From 1988 to 2008, 28 (80.0%) of 35 uncorrectable type of BA patients became jaundice-free after HPE. Of these 28 patients, this retrospective study included comparisons of the preoperative characteristics, postoperative jaundice period, cumulative steroid dose, outcome, and liver fibrosis grade at the time of HPE between CDIB-positive and -negative groups, divided by postoperative ultrasonography findings.


RESULTS
There were no differences between groups in perioperative characteristics. Liver fibrosis in the CDIB-positive group (n = 7) included grade II in two patients, grade III in four patients, and grade IV in one patient. On the contrary, the CDIB-negative group (n = 21) included 8, 11, 2, and 0 patients with grades I-IV, respectively, with a significant difference (p < 0.05) between groups. Survival rate with native liver in CDIB-positive group was significantly lower than that in CDIB-negative group (p < 0.05).


CONCLUSIONS
Postoperative CDIB might be a poor prognostic factor, and the liver fibrosis grade at the time of HPE could be helpful to predict the development of CDIB after HPE.
Shimadera
Shinichi
S
Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. sshima@koto.kpu-m.ac.jp
Iwai
Naomi
N
Deguchi
Eiichi
E
Kimura
Osamu
O
Ono
Shigeru
S
Furukawa
Taizou
T
Fumino
Shigehisa
S
D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D001656:Biliary Atresia / Q000150:complications / Q000601:surgery*; D003560:Cysts / Q000209:etiology; D004108:Dilatation, Pathologic / Q000209:etiology; D006801:Humans; D007223:Infant; D007565:Jaundice / Q000209:etiology; D008103:Liver Cirrhosis / Q000209:etiology*; D016031:Liver Transplantation; D011171:Portoenterostomy, Hepatic / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors