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Preoperative Serum IL-12p40 Is a Potential Predictor of Kasai Portoenterostomy Outcome in Infants with Biliary
Shaimaa Samy Goda1, Mohamed Ahmed Khedr1, Soha Zaki Elshenawy2
1Department of Pediatric Hepatology, Gastroenterology and Nutrition, National Liver Institute, Menoufia University, Shebin El-Koom, Menoufia 32511, Egypt.
Insights
Serum interleukin-12p40 (IL-12p40) levels can predict the success of Kasai portoenterostomy surgery for biliary atresia (BA). Higher preoperative IL-12p40 indicates a better surgical outcome in infants with BA.
Area of Science:
- Pediatric Surgery
- Immunology
- Neonatal Medicine
Background:
- Biliary atresia (BA) is a severe neonatal liver disease requiring surgical intervention.
- Kasai portoenterostomy is the standard surgical treatment to restore bile flow.
- Interleukin-12p40 (IL-12p40) is a natural antagonist to the pro-inflammatory IL-12p70.
Purpose of the Study:
- To investigate the relationship between serum IL-12p40 levels and the surgical outcomes of Kasai portoenterostomy in infants with BA.
- To determine if IL-12p40 can serve as a predictive biomarker for surgical success in BA.
Main Methods:
- Serum IL-12p40 was measured using ELISA in 75 infants with neonatal cholestasis (BA, non-BA cholestasis, neglected BA) and 30 healthy controls.
- IL-12p40 levels were assessed preoperatively and 3 months postoperatively in the BA group.
- Surgical success was defined as serum bilirubin levels ≤ 2 mg/dl.
Main Results:
- Preoperative IL-12p40 was significantly higher in the BA group compared to non-BA cholestasis and control groups.
- Higher preoperative IL-12p40 levels in BA patients correlated with successful Kasai portoenterostomy outcomes.
- A cutoff level of 547.47 pg/ml predicted successful Kasai outcomes with 87.5% sensitivity and 82.4% specificity.
- Postoperative IL-12p40 levels showed a tendency to decrease in both successful and failed surgical groups.
Conclusions:
- Preoperative serum IL-12p40 is a potential biomarker for predicting the success of Kasai portoenterostomy in biliary atresia.
- Serial postoperative IL-12p40 measurements may help anticipate the failure of initially successful operations, guiding decisions for liver transplantation.
Abstract:
The standard-of-care treatment for biliary atresia (BA) is surgical restoration of bile flow by Kasai portoenterostomy. We aimed to study serum interleukin- (IL-) 12p40, a natural antagonist for the proinflammatory IL-12p70, and its relation to surgical outcomes of BA. The study included 75 infants with neonatal cholestasis: BA group (n = 25), non-BA cholestasis group (n = 30), and neglected BA group (n = 20), in addition to thirty healthy neonates serving as controls. IL-12p40 was measured by ELISA in all individuals and a second assessment was performed 3 months postoperatively in the BA group. The surgical outcomes were classified as successful (bilirubin ≤ 2 mg/dl) or failed (bilirubin > 2 mg/dl). IL-12p40 was higher in BA compared to that in the non-BA and control groups (P values were 0.036 and <0.0001, resp.) but comparable to that in the neglected BA group. Preoperative IL-12p40 levels in BA patients were significantly higher in successful Kasai compared with failed Kasai and a cutoff level of 547.47 pg/ml could predict the successful outcome with 87.5% sensitivity and 82.4% specificity. Three-month postoperative IL-12p40 tended to decrease in both the successful and failed groups. In conclusion, preoperative serum IL-12p40 is a potential predictor of Kasai outcome. Serial postoperative measurements may anticipate the failure of an initially successful operation, hence the need for liver transplantation.
