Liver and portal histopathological correlation with age and survival in extra hepatic biliary atresia

To grade histopathological parameters in biliary atresia (BA) and correlate it with advancing age and outcome.

Liver and porta hepatis biopsies of 18 BA cases were graded for cholestasis (C), hepatocellular degeneration (HD), bile duct proliferation (BDP), bile duct fibrosis (BDF), bile duct inflammation (BDI), portal edema (PE), portal inflammation (PI) and portal fibrosis (PF) with a total histopathological score (THS) of 25. Confidence intervals were calculated. Image analysis at porta hepatis for largest subhepatic bile ductule diameter (BDD) and area was correlated with liver histopathology. Patients were followed up to at least 1 year after surgery. Four cases of neonatal autopsies were taken as control.

Mean age at Kasai was 95.5 + 32.03 (51-172) days. Mean THS was 16.83 + 2.57 (13-23) with no significant difference in relation to age <90; >90 days (p = 0.4410) or age <60; 61-90; 91-120; >121 days (p = 0.6549). There was no significant difference with relation to age in grading of parameters; C (p = 1.000) HD (p = 0.638), BDP (p = 0.530), BDF (p = 0.342), BDI (p = 0.395), PE (p = 0.476), PI (p = 0.342), PF (p = 0.530), BDD (p = 0.1097) and area (p = 0.1097). There was no significant difference between survival and age at operation (p = 0.4178) or THS (p = 0.3025).

Advanced histopathological findings even at younger age suggests the need to consider BA as an emergency.