Changes of bile duct pathology in children with biliary atresia after Kasai portoenterstomy

Abstract

Objective To explore the changes of intrahepatic bile duct structure in children with biliary atresia (BA) after Kasai portoenterstomy (KP) and analyze the relationship with cholangioitis so as to provide therapeutic rationales for cholangioitis.Methods Liver specimens after KP were collected intraoperatively in 8 (6 males,2 females) patients with liver transplantation between January 2013 and June 2013.The clinical data of patients included:occurring time of jaundice was 3-20 days and operative duration within 44-85 days,frequency of cholangioitis 1-6 times or persistent status,The interval time between Kasai operation and liver transplantation were 6-66 months.Also liver biopsy specimens were collected intraoperatively in 8 patients as controls.Hematoxylin & eosin (HE) and immunohistochemical (IHC) staining were employed for detecting the portal area with regards to interlobular bile duct diameter,lumen number; hyperplasia degree of interlobular bile duct,interlobular bile thrombi; inflammatory cell infiltration; bile duct plate malformation; proportion of bile duct proliferation and hyperplasia of fibrous tissue to analyze the relationship with cholangioitis.Results Control group:bile duct hyperplasia was severe (n =4) and mild (n =4); bile duct diameter ＜30μm; mild hyperplasia of bile duct epithelium,bile duct reaction was more severe; the ratio of bile duct hyperplasia and fiber proliferation ＜ 1/4; inflammatory cell infiltration was severe.Experimental group:bile duct hyperplasia was severe (n =6) and mild (n =2) ; bile duct diameter ＞100 μm (n =1) and ＜30 μm (n =7) ; bile duct epithelial hyperplasia and bile duct reaction were severe; percentage of bile duct hyperplasia and fiber hyperplasia between 1/2-3/4; inflammation cell infiltration was severe (n =2) and mild (n =6).For BA children operated earlier,the frequency of cholangioitis were less,bile duct hyperplasia was relatively mild,interlobular bile duct diameter was larger,liver transplant time delayed,their liver specimens after KP showed severe fibrosis and bile duct proliferation.While inflammatory cell infiltration and bile thrombi were milder.Conclusions Among BA children after KP,intrahepatic bile duct changes including hyperplasia of periportal bile duct,bile duct proliferation and fibrous tissue hyperplasia and open bile duct diameter may impact on the frequency of cholangioitis.Early Kasai operation is recommended to reduce bile duct injury and prolong autologous liver survival time. Key words: Biliary atresia; Cholangioitis; Liver transplantation