Changes of hepatic pathology in children with biliary atresia after Kasai portoenterstomy

Abstract

Objective To explore the characteristic changes of hepatic pathology in children with biliary atresia （BA）after Kasai portoenterstomy （KP）and analyze the relation with the degree of hepatic damage and cholangitis.Methods A retrospective study was conducted for 16 consecutive BA patients between May 2012 and December 2012.Eight （7 males,1 females）patients of one group underwent hepatic transplantation and a removal of native liver.And another 8 patients underwent Kasai procedure.And hepatic specimens were collected intra-operatively.The pathology of hepatic tissue from two groups was studied.Another 2 specimens of hepatic tissue were harvested from neonatal autopsy as negative control.Pathological examinations included hematoxylin ＆ eosin and immunohistochemical staining for evaluating grade of hepatic fibrosis,extension of bile duct,vascular proliferation,degree of hepatocellular damage and infiltration of inflammatory cells.Results There were swelling,severe cholestasis and medium texture in the control group.The grading of hepatic fibrosis was between Ⅱ-Ⅳ,portal bile plugs 0-Ⅰ,vascular proliferation Ⅲ-Ⅳ and bile duct proliferation Ⅰ-Ⅲ.Macroscopically,the liver specimens of experimental group had more atrophic areas.Grading of hepatic fibrosis was divided into level Ⅳ,portal bile plugs Ⅰ-Ⅱ,portal vascular proliferation Ⅳ and proliferation of bile duct Ⅲ-Ⅳ.Combined with clinical data,earlier Kasai operation was associated with less frequency of cholangitis.And hypertrophic area was more than atrophic area. Meanwhile,there was severe hepatic fibrosis,but bile duct proliferation was relatively mild.Late Kasai ＇s procedures had a worse prognosis.And some children showed persistent cholangitis and a short survival period.Conclusions The pathological changes after hepatic removal have characteristic manifestations.Hepatic damage and timing of KP are the risk factors of cholangitis in BA patients after KP. Key words: Biliary atresia Cholangitis Liver Pathology