Abstract
Background: Biliary atresia (BA) is a neonatal cholangiopathy characterized by progressive destruction of the biliary system resulting in liver cirrhosis. Residual bile drainage can temporarily be achieved through Kasai portoenterostomy (KPE) and some children show long-term survival with their native liver. However, most children eventually require liver transplantation (LTX). As several growth factors (GF) and chemokines have been shown to promote fibrogenesis in the liver, we assessed whether GF are predictive for the course of disease. Material and Methods: Liver and sera samples were collected from 49 infants with BA during KPE. Levels of 13 different GF were measured by multiplex immunoassay. Patient outcomes were stratified into favorable (bilirubin < 20 µmol/L at 2-year follow-up) and unfavorable (LTX). GF levels were compared between groups by a t-test, correlation coefficients were calculated, and principal component analyses performed. Results: Twenty-two patients showed a favorable and 27 an unfavorable disease course. No relation of GF and outcome could be established. In both groups, high levels of SDF-1alpha/CXCL12 (1473.0 ± 497.5 pg/mL), FGF2 (301.2 ± 207.8 pg/mL), and VEGF-a (209.0 ± 146.4 pg/mL) levels were measured within the liver, followed (in descending order) by PDGF-bb, LIF, GM-CSF, BDNF, VEGF-d, beta-NGF, IL-7, SCF, PIGF-1, and EGF. Serum marker levels showed much higher mean variation compared to hepatic values and no correlation to the protein microenvironment in the liver. Conclusions: Our study demonstrates high amounts of GF in livers from infants with BA at KPE, but no correlation to the outcome or serum values could be established. Our data suggest that local or systemic GF levels are unsuitable for prediction of the disease course. Collectively, we conclude that in BA the degree of proliferative activity caused by GF is a dismissible factor for the further course of disease.
Highlights
Biliary atresia (BA) is a rare fibro-obliterative disease, manifesting within the first weeks of life, and resulting in end-stage liver cirrhosis [1]. This continuous progress to liver deterioration can be interrupted with the Kasai portoenterostomy (KPE) by restoring some bile drainage in up to 60% of operated infants [2]
Only a few markers are indicative for a favorable post-KPE course of disease, including the age at operation with significantly better results when children are less than 60 days of age at KPE [6]
An early prognostic indicator for the post-KPE disease dynamics is crucial to solve the major problem of late referral of patients to pediatric liver units, as registry data show that the pediatric mortality on transplant waiting lists is up to 20% [15]
Summary
Biliary atresia (BA) is a rare fibro-obliterative disease, manifesting within the first weeks of life, and resulting in end-stage liver cirrhosis [1]. This continuous progress to liver deterioration can be interrupted with the Kasai portoenterostomy (KPE) by restoring some bile drainage in up to 60% of operated infants [2]. The most important postoperative marker for the KPE outcome is the serum bilirubin, which shows a significant correlation with the infant’s survival with native liver [7,8].
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