title: A high serum interleukin-12p40 level prior to Kasai surgery predict a favourable outcome in children with biliary atresia.
abstract: BACKGROUND
  Biliary atresia (BA) is a paediatric cholestatic disease characterized by a progressive fibro-inflammation of the biliary tree. Current treatment of choice is to establish good bile flow via the Kasai operation.
  
  
  OBJECTIVE
  We aimed to identify outcome-predictive serum biomarkers in BA infant.
  
  
  METHODS
  Thirty-three BA children recruited from 1986 to 2007 served as the baseline-study group. An additional 11 children recruited from 2008 to 2011 served as the validation group. Serum samples were collected immediately before and 6 months after the Kasai operation for the assessment of serum cytokines, including tumour necrosis factor-α (TNF-α), transforming growth factor-β (TGF-β), interferon-γ (IFN-γ), interleukin-2 (IL-2), IL-10, IL-12p40 and IL-12p70 as the candidate biomarkers.
  
  
  RESULTS
  Increased serum TGF-β levels indicated a lower Knodell hepatitis activity index at Kasai operation. The serum TGF-β levels declined after the operation. Serum IL-12p40 levels before the Kasai operation were higher in the subjects with a 3-month jaundice-free status than in others (P = 0.001). A serum pre-operative IL-12p40 level of 33 pg/ml was predictive of a 3-month jaundice-free status after surgery (positive predictive value=81.0%; negative predictive value=83.3%). This biomarker was also predictive of a better outcome, in terms of 3-year survival with native liver (risk ratio [RR = 4.00]; P < 0.001), and 3-year jaundice-free survival with native liver (RR = 12.00; P < 0.001). We confirmed the predictive power of a high pre-operative IL-12p40 level on 3-month jaundice-free status in the validation group.
  
  
  CONCLUSIONS
  The pre-operative IL-12p40 level was a good predictive biomarker of clinical outcome in children with BA undergoing the Kasai operation.
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jia-Feng
authors.initials: JF
authors.lastname: Wu
authors.forename: Pei-Chi
authors.initials: PC
authors.lastname: Kao
authors.forename: Huey-Ling
authors.initials: HL
authors.lastname: Chen
authors.forename: Hong-Shiee
authors.initials: HS
authors.lastname: Lai
authors.forename: Hong-Yuan
authors.initials: HY
authors.lastname: Hsu
authors.forename: Mei-Hwei
authors.initials: MH
authors.lastname: Chang
authors.forename: Yen-Hsuan
authors.initials: YH
authors.lastname: Ni
mesh_terms: D001656:Biliary Atresia / Q000097:blood* / Q000601:surgery*; D015415:Biomarkers / Q000097:blood*; D005260:Female; D006801:Humans; D007223:Infant; D053762:Interleukin-12 Subunit p40 / Q000097:blood*; D041781:Jaundice, Obstructive / Q000473:pathology* / Q000517:prevention & control; D008297:Male; D016017:Odds Ratio; D011171:Portoenterostomy, Hepatic / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D053762:Interleukin-12 Subunit p40