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Impaired T-lymphocyte proliferation function in biliary atresia patients with chronic cholestatic jaundice after a
Jia-Feng Wu1, Bor-Luen Chiang, Huey-Ling Chen
1Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
Insights
Children with biliary atresia (BA) and chronic jaundice show impaired T-lymphocyte function. This immune deficiency increases their risk of severe infections, highlighting a critical link between jaundice and complications in BA patients.
Area of Science:
- Immunology
- Pediatric Gastroenterology
Background:
- Biliary atresia (BA) is a serious neonatal liver disease.
- Chronic cholestatic jaundice in BA patients may impact systemic immunity and infection risk.
Purpose of the Study:
- To assess systemic immune function in children with BA.
- To determine the association between chronic cholestatic jaundice and infectious complications in BA.
Main Methods:
- Evaluated immune parameters (immunoglobulins, complement, T-lymphocyte response, cytokine production, cell counts) in 30 BA patients.
- Divided patients into jaundice and control groups based on bilirubin levels.
- Monitored for severe infectious complications over six months.
Main Results:
- BA patients with chronic cholestatic jaundice exhibited significantly lower T-lymphocyte proliferation response to phytohemagglutinin (PHA) stimulation (p = 0.02).
- Chronic cholestatic jaundice in BA was associated with a 5.87-fold increased risk of severe infectious complications (p = 0.001).
Conclusions:
- Chronic cholestatic jaundice in biliary atresia is linked to impaired T-lymphocyte immunity.
- These immune deficits contribute to a higher incidence of severe infections in BA patients with persistent jaundice.
Abstract:
To investigate the association between chronic cholestatic jaundice, systemic immunity, and various infectious complications in patients with biliary atresia (BA), we performed a survey of the systemic immune function in 30 children with BA. Patients were divided into a jaundice group (total serum bilirubin > or = 2 mg/dL for >6 mo) and control group (total serum bilirubin <2 mg/dL for >6 mo) with comparable age. Patients were tested for serum immunoglobulin and complement levels, mitogen response, interleukin (IL)-4, IL-5, and interferon-gamma production after phytohemagglutinin (PHA) stimulation, blood cell and lymphocyte subpopulation counts, phagocytic function, and leukocyte adhesion complex. They were then followed prospectively for 6 mo, and severe infectious complications requiring hospitalization were recorded. Compared with jaundice-free patients, T-lymphocyte proliferation function, determined by PHA mitogen test was significantly lower (p = 0.02) in BA patients with chronic cholestatic jaundice after a Kasai operation. During the study period, patients with chronic cholestatic jaundice had a higher risk of severe infectious complications than their jaundice-free counterparts (risk ratio = 5.87; p = 0.001). In conclusion, BA patients with chronic cholestatic jaundice are associated with impairment of T-lymphocyte proliferation and increased incidence of severe infectious complications.
