title: Impact of ductal plate malformation on survival with native liver in children with biliary atresia.
abstract: OBJECTIVE
  Ductal plate malformation (DPM) like arrays in the liver which resemble the characteristic persistent embryonal ductular structures have been shown to adversely affect the outcome of Kasai portoenterostomy (KPE) in biliary atresia (BA). We studied the impact of DPM on survival with native liver (SNL) in children with BA who underwent liver transplantation (LT) after KPE as well as those who underwent primary LT without KPE.
  
  
  METHODS
  Records of children with BA who underwent LT in our institute were reviewed and divided into three groups-Group 1 had primary LT because of delayed diagnosis of BA and synthetic liver failure, Group 2 had LT for synthetic liver failure after a failed KPE, and Group 3 had LT despite clearing jaundice after KPE for other indications. The impact of DPM on SNL was analyzed using standard statistical means.
  
  
  RESULTS
  In Group 1 (n = 26) and Group 2 (n = 26), the incidence of DPM was high and was associated with a significantly shorter SNL compared to children with no DPM. The incidence of DPM was significantly lower in Group 3 (n = 13).
  
  
  CONCLUSIONS
  DPM shortens SNL and influences the pathogenesis of disease progression in children with BA who had synthetic liver failure requiring transplantation either because of a failed KPE or due to a delay in diagnosis. Its incidence is low in children who cleared jaundice after KPE and needed transplantation for other indications at a later age. The presence of DPM signifies an adverse outcome for the disease.
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, #439, Cheran Nagar, Perumbakkam, Chennai, 600 100, India.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Safwan
authors.forename: Priya
authors.initials: P
authors.lastname: Ramachandran
authors.forename: Mukul
authors.initials: M
authors.lastname: Vij
authors.forename: Naresh
authors.initials: N
authors.lastname: Shanmugam
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
mesh_terms: D000293:Adolescent; D001652:Bile Ducts / Q000002:abnormalities*; D001656:Biliary Atresia / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008099:Liver / Q000002:abnormalities* / Q000601:surgery*; D008297:Male; D011171:Portoenterostomy, Hepatic; D013194:Staining and Labeling; D015996:Survival Rate; D016896:Treatment Outcome