Pediatric Surgery International

, Volume 27, Issue 3, pp 275–277 | Cite as

How valuable is ductal plate malformation as a predictor of clinical course in postoperative biliary atresia patients?

  • Rumi Arii
  • Hiroyuki Koga
  • Atsushi Arakawa
  • Katsumi Miyahara
  • Geoffrey J. Lane
  • Tadaharu Okazaki
  • Masahiko Urao
  • Atsuyuki Yamataka
Original Article
First Online:

Abstract

Purpose

We assessed ductal plate malformation (DPM) as a prognostic factor for mid-/long-term outcome in post-hepatoportoenterostomy (HPE) biliary atresia patients.

Methods

Of 78 cases of HPE performed between 1989 and 2009, biopsy specimens were available for 43. Cytokeratin 19 was used to identify DPM and preoperative status, postoperative serum total bilirubin, time taken to become jaundice-free, duration of jaundice-free period, steroid usage, incidences of cholangitis, bile lakes, and varices, and requirement for reoperation and liver transplantation were compared.

Results

DPM was detected in 21/43 (48.8%) subjects [DPM-positive (DPM+)]. Differences were identified for maximum postoperative serum total bilirubin: DPM+ (12.28 ± 1.00 mg/dL) versus DPM-negative (DPM−) (9.67 ± 0.71 mg/dL) (P < 0.05) and total steroid usage: DPM+ (98.3 ± 11.8 mg/kg) versus DPM− (83.4 ± 15.9 mg/kg) (P = NS). However, total steroid dose in jaundice-free cases was significantly higher in DPM+ [75.3 ± 10.0 mg/kg (n = 14) vs. 48.1 ± 6.4 mg/kg (n = 19); P < 0.05)]. There were no differences for complications. Mean duration of follow-up was significantly shorter for DPM+ (60.9 ± 38.4 vs. 113.8 ± 56.9 months; P < 0.05).

Conclusion

Postoperative total bilirubin was higher in DPM+ cases, thus higher doses of steroids were required. However, DPM+ did not appear to influence the incidence of complications mid-/long-term.

Keywords

Biliary atresia Ductal plate malformation Jaundice Mid-/long-term follow-up 
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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Rumi Arii
    • 1
  • Hiroyuki Koga
    • 1
  • Atsushi Arakawa
    • 2
  • Katsumi Miyahara
    • 1
  • Geoffrey J. Lane
    • 1
  • Tadaharu Okazaki
    • 1
  • Masahiko Urao
    • 1
  • Atsuyuki Yamataka
    • 1
  1. 1.Department of Pediatric General and Urogenital SurgeryJuntendo University School of MedicineTokyoJapan
  2. 2.Department of PathologyJuntendo University School of MedicineTokyoJapan

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