Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Nio M (2017) Japanese biliary atresia registry. Pediatr Surg Int 33(12):1319–1325

    Article  Google Scholar 

  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):529–537

    Article  Google Scholar 

  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:e127

    Article  CAS  Google Scholar 

  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):851–858

    Article  Google Scholar 

  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)

  6. Kanda Y (2013) Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transpl 48(3):452–458

    Article  CAS  Google Scholar 

  7. Desmet VJ (1992) Congenital diseases of intrahepatic bile ducts: variations on the theme "ductal plate malformation". Hepatology 16(4):1069–1083

    Article  CAS  Google Scholar 

  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):10–14

    Article  CAS  Google Scholar 

  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):152–159

    Article  CAS  Google Scholar 

  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):63–66

    Article  CAS  Google Scholar 

  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):2412–2415

    Article  Google Scholar 

  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):877–881

    Article  Google Scholar 

  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):892–896

    Article  Google Scholar 

  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):1297–1301

    Article  CAS  Google Scholar 

  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):1017–1025

    Article  CAS  Google Scholar 

  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):351–357

    Article  CAS  Google Scholar 

  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):263–267

    CAS  PubMed  PubMed Central  Google Scholar 

  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):1249–1253

    Article  Google Scholar 

  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):79–87

    Article  CAS  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan

    Toshio Harumatsu, Toshihiro Muraji, Ryuta Masuya, Taichiro Nagai, Keisuke Yano, Shun Onishi, Koji Yamada, Waka Yamada, Makoto Matsukubo, Mitsuru Muto, Tatsuru Kaji & Satoshi Ieiri

  2. Department of Pediatric Surgery, Kirishima Medical Center, Kagoshima, Japan

    Toshihiro Muraji

  3. Department of Pathology, Ibaraki Children’s Hospital, Mito, Japan

    Haruo Ohtani

  4. Clinical Training Center, Kagoshima University Hospital, Kagoshima, Japan

    Waka Yamada & Tatsuru Kaji

Authors
  1. Toshio Harumatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshihiro Muraji
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryuta Masuya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haruo Ohtani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Taichiro Nagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keisuke Yano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shun Onishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Koji Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Waka Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Makoto Matsukubo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mitsuru Muto
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tatsuru Kaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Satoshi Ieiri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Satoshi Ieiri.

Ethics declarations

Conflict of interest

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harumatsu, T., Muraji, T., Masuya, R. et al. 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. Pediatr Surg Int 35, 1437–1441 (2019). https://doi.org/10.1007/s00383-019-04579-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-019-04579-x

Keywords

Search

Navigation