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Pediatric Surgery International

, Volume 35, Issue 12, pp 1437–1441 | Cite as

Microvascular proliferation of the portal vein branches in the liver of biliary atresia patients at Kasai operation is associated with a better long-term clinical outcome

  • Toshio Harumatsu
  • Toshihiro Muraji
  • Ryuta Masuya
  • Haruo Ohtani
  • Taichiro Nagai
  • Keisuke Yano
  • Shun Onishi
  • Koji Yamada
  • Waka Yamada
  • Makoto Matsukubo
  • Mitsuru Muto
  • Tatsuru Kaji
  • Satoshi IeiriEmail author
Original Article
  • 51 Downloads

Abstract

Aim of the study

We previously showed an increased number of smaller portal vein (PV) branches in the portal areas of liver biopsy specimens of biliary atresia (BA) patients. We evaluated the correlation between this histopathological feature and the prognosis.

Patients and methods

Twenty-five consecutive patients with BA encountered between 2000 and 2012 were classified into three prognostic groups based on their postoperative outcomes: Excellent (n = 11) for native-liver survivors with a normal liver function, Good (n = 6) for native-liver survivors with liver dysfunction, and Poor (n = 8) for survivors after liver transplant or on a waiting list. Data from morphometrical analyses, including the fibrotic portal area, numbers of PVs, diameter and total area of PV branches, were statistically compared among the three groups.

Main results

The number of PV branches per unit area of the whole-liver specimen in the poor prognostic group was significantly lower than that in the excellent group (3.1 ± 0.6 vs. 5.2 ± 2.0/mm2, p = 0.03). There were no significant differences in the other parameters.

Conclusions

This is the first report on the relationships between morphometrically analyzed PV branches and the postoperative course in BA patients. The portal venous system is involved as the primary lesion in BA.

Keywords

Biliary atresia Portal vein Hepatic artery Morphometrical analysis Postoperative course 

Notes

Acknowledgments

We thank Mr. Brian Quinn for his comments and help with the manuscript. This study was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS: 19K10485, 19K09150, 19K09078, 19K03084, 19K18061, 19K17304, 19K18032, 18K08578, 18K16262 17K10555, 17K11514, 17K10183, 17K11515, 16K10466, 16K10094, 16K10095, 16K10434, 16H07090) and Grant from Kawano Masanori Memorial Foundation for Promotion of Pediatrics.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest in association with the present study.

References

  1. 1.
    Nio M (2017) Japanese biliary atresia registry. Pediatr Surg Int 33(12):1319–1325CrossRefGoogle Scholar
  2. 2.
    Masuya R, Muraji T, Ohtani H, Mukai M, Onishi S, Harumatsu T, Yamada K, Yamada W, Kawano T, Machigashira S, Nakame K, Kaji T, Ieiri S (2019) Morphometric demonstration of portal vein stenosis and hepatic arterial medial hypertrophy in patients with biliary atresia. Pediatr Surg Int 35(5):529–537CrossRefGoogle Scholar
  3. 3.
    Tomita H, Fuchimoto Y, Fujino A, Hoshino K, Yamada Y, Masugi Y, Sakamoto M, Kasahara M, Kanamori Y, Nakazawa A, Yoshida F, Akatsuka S, Nakano M, Kuroda T (2015) Development and validation of a novel fibrosis marker in biliary atresia during infancy. Clin Transl Gastroenterol 6:e127CrossRefGoogle Scholar
  4. 4.
    Freeman RB Jr, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E, Merion R, Wolfe R, Turcotte J, Teperman L, Unos/Optn Liver Disease Severity Score UOL, Intestine, Committees UOPT (2002) The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl 8(9):851–858CrossRefGoogle Scholar
  5. 5.
    Colecchia A, Festi D, di Biase AR (2012) Noninvasive parameters for predicting esophageal varices in children: their sequential use provides the best accuracy. Gastroenterology 142(2):e32 (author reply e32–33) Google Scholar
  6. 6.
    Kanda Y (2013) Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transpl 48(3):452–458CrossRefGoogle Scholar
  7. 7.
    Desmet VJ (1992) Congenital diseases of intrahepatic bile ducts: variations on the theme "ductal plate malformation". Hepatology 16(4):1069–1083CrossRefGoogle Scholar
  8. 8.
    Ohuchi N, Ohi R, Takahashi T, Kasai M (1986) Postoperative changes of intrahepatic portal veins in biliary atresia—a 3-D reconstruction study. J Pediatr Surg 21(1):10–14CrossRefGoogle Scholar
  9. 9.
    Kasai M, Okamoto A, Ohi R, Yabe K, Matsumura Y (1981) Changes of portal vein pressure and intrahepatic blood vessels after surgery for biliary atresia. J Pediatr Surg 16(2):152–159CrossRefGoogle Scholar
  10. 10.
    Kang N, Davenport M, Driver M, Howard ER (1993) Hepatic histology and the development of esophageal varices in biliary atresia. J Pediatr Surg 28(1):63–66CrossRefGoogle Scholar
  11. 11.
    Nio M, Wada M, Sasaki H, Tanaka H, Nakamura M, Kudo H (2018) Using (99m)Tc-DTPA galactosyl human serum albumin liver scintigraphy as a prognostic indicator in jaundice-free patients with biliary atresia. J Pediatr Surg 53(12):2412–2415CrossRefGoogle Scholar
  12. 12.
    Fujisawa S, Muraji T, Sakamoto N, Hosaka N, Matsuda S, Kawakami H, Hirai M, Yanai T (2014) Positive C4d staining of the portal vein endothelium in the liver of patients with biliary atresia: a role of humoral immunity in ongoing liver fibrosis. Pediatr Surg Int 30(9):877–881CrossRefGoogle Scholar
  13. 13.
    Kobayashi H, Li Z, Yamataka A, Lane GJ, Miyano T (2003) Role of immunologic costimulatory factors in the pathogenesis of biliary atresia. J Pediatr Surg 38(6):892–896CrossRefGoogle Scholar
  14. 14.
    Kobayashi H, Horikoshi K, Long L, Yamataka A, Lane GJ, Miyano T (2001) Serum concentration of adhesion molecules in postoperative biliary atresia patients: relationship to disease activity and cirrhosis. J Pediatr Surg 36(8):1297–1301CrossRefGoogle Scholar
  15. 15.
    Davenport M, Gonde C, Redkar R, Koukoulis G, Tredger M, Mieli-Vergani G, Portmann B, Howard ER (2001) Immunohistochemistry of the liver and biliary tree in extrahepatic biliary atresia. J Pediatr Surg 36(7):1017–1025CrossRefGoogle Scholar
  16. 16.
    Reynoso-Paz S, Coppel RL, Mackay IR, Bass NM, Ansari AA, Gershwin ME (1999) The immunobiology of bile and biliary epithelium. Hepatology 30(2):351–357CrossRefGoogle Scholar
  17. 17.
    Dillon P, Belchis D, Tracy T, Cilley R, Hafer L, Krummel T (1994) Increased expression of intercellular adhesion molecules in biliary atresia. Am J Pathol 145(2):263–267PubMedPubMedCentralGoogle Scholar
  18. 18.
    Muraji T, Ohtani H, Ieiri S (2017) Unique manifestations of biliary atresia provide new immunological insight into its etiopathogenesis. Pediatr Surg Int 33(12):1249–1253CrossRefGoogle Scholar
  19. 19.
    Mack CL, Tucker RM, Sokol RJ, Karrer FM, Kotzin BL, Whitington PF, Miller SD (2004) Biliary atresia is associated with CD4+ Th1 cell-mediated portal tract inflammation. Pediatr Res 56(1):79–87CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Toshio Harumatsu
    • 1
  • Toshihiro Muraji
    • 1
    • 2
  • Ryuta Masuya
    • 1
  • Haruo Ohtani
    • 3
  • Taichiro Nagai
    • 1
  • Keisuke Yano
    • 1
  • Shun Onishi
    • 1
  • Koji Yamada
    • 1
  • Waka Yamada
    • 1
    • 4
  • Makoto Matsukubo
    • 1
  • Mitsuru Muto
    • 1
  • Tatsuru Kaji
    • 1
    • 4
  • Satoshi Ieiri
    • 1
    Email author
  1. 1.Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education AssemblyKagoshima UniversityKagoshima CityJapan
  2. 2.Department of Pediatric SurgeryKirishima Medical CenterKagoshimaJapan
  3. 3.Department of PathologyIbaraki Children’s HospitalMitoJapan
  4. 4.Clinical Training CenterKagoshima University HospitalKagoshimaJapan

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