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Impact of ductal plate malformation on survival with native liver in children with biliary atresia

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Abstract

Purpose

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).

Conclusion

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.

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Authors and Affiliations

  1. Institute of Liver Disease and Transplantation, Global Health City, #439, Cheran Nagar, Perumbakkam, Chennai, 600 100, India

    Mohamed Safwan, Priya Ramachandran, Naresh Shanmugam & Mohamed Rela

  2. Department of Pediatric Surgery, Kanchi Kamakoti CHILDS Trust Hospital, CHILDS Trust Medical Research Foundation, 12 A Nageshwara Road, Nungambakkam, Chennai, 600034, India

    Priya Ramachandran

  3. National Foundation for Liver Research, #439, Cheran Nagar, Perumbakkam, Chennai, 600 100, India

    Priya Ramachandran, Naresh Shanmugam & Mohamed Rela

  4. Department of Pathology, Global Health City, #439, Cheran Nagar, Perumbakkam, Chennai, 600 100, India

    Mukul Vij

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  1. Mohamed Safwan
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  2. Priya Ramachandran
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  4. Naresh Shanmugam
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Correspondence to Priya Ramachandran.

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Safwan, M., Ramachandran, P., Vij, M. et al. Impact of ductal plate malformation on survival with native liver in children with biliary atresia. Pediatr Surg Int 31, 837–843 (2015). https://doi.org/10.1007/s00383-015-3728-6

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  • DOI: https://doi.org/10.1007/s00383-015-3728-6

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