Higashio Atsushi, Yoshioka Takako, Kanamori Yutaka, Fujino Akihiro, Morotomi Yoshiki, Shibata Toshihiko, Nakaoka Tatsuo
Department of Surgery, Osaka Metropolitan University School of Medicine, Osaka, Japan.
Department of Pathology, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.
Clin Pathol. 2022 Oct 31;15:2632010X221132686. doi: 10.1177/2632010X221132686. eCollection 2022 Jan-Dec.
Biliary atresia (BA) is a progressive obstructive hepatic disease that requires early diagnosis and the prompt initiation of treatment. Although portoenterostomy (PES) is usually performed as the initial surgical procedure, the liver damage may subsequently progress, such that liver transplantation (LTx) may be required. In this study, we comprehensively evaluated the histopathology of liver samples collected during PES and retrospectively evaluated its relationship with prognosis.
Forty-seven patients with BA who underwent PES between 2002 and 2021 were included. Their biopsy samples were semi-quantitatively graded according to the severity of liver fibrosis, bile duct proliferation, cholestasis, ductal plate malformation, and inflammatory cell infiltration; and the expression of cluster of differentiation (CD)3, CD20, human leukocyte antigen II-DR, and α-smooth muscle actin (α-SMA). The relationships of each with the prevalence of survival with native liver (SNL) were evaluated to identify prognostic markers.
The median postoperative duration of follow-up was 11.8 years (maximum, 18.0 years; minimum, 3.5 years). There were no deaths during this period, but LTx was performed in 31 patients and the final prevalence of SNL was 34.0% (16/47). There were negative correlations of liver fibrosis and α-SMA with SNL, and a positive correlation between CD20 and SNL. Multivariate analysis using a proportional hazards regression model showed that only CD20 expression was significant.
Comprehensive histopathological analysis of liver biopsy samples obtained at the time of PES showed a positive correlation between CD20 expression and SNL, suggesting that this may represent a useful prognostic marker.
III.
胆道闭锁（BA）是一种进行性梗阻性肝病，需要早期诊断并及时开始治疗。尽管通常将肝门空肠吻合术（PES）作为初始外科手术，但肝损伤随后可能会进展，因此可能需要进行肝移植（LTx）。在本研究中，我们全面评估了在PES期间采集的肝脏样本的组织病理学，并回顾性评估了其与预后的关系。
纳入2002年至2021年间接受PES的47例BA患者。根据肝纤维化、胆管增生、胆汁淤积、胆管板畸形和炎性细胞浸润的严重程度，对其活检样本进行半定量分级；并检测分化簇（CD）3、CD20、人类白细胞抗原II-DR和α-平滑肌肌动蛋白（α-SMA）的表达。评估各项指标与自体肝存活（SNL）发生率的关系，以确定预后标志物。
术后中位随访时间为11.8年（最长18.0年；最短3.5年）。在此期间无死亡病例，但31例患者接受了LTx，SNL的最终发生率为34.0%（16/47）。肝纤维化和α-SMA与SNL呈负相关，CD20与SNL呈正相关。使用比例风险回归模型进行的多变量分析显示，只有CD20表达具有显著性。
对PES时获得的肝脏活检样本进行全面的组织病理学分析显示，CD20表达与SNL呈正相关，提示这可能是一个有用的预后标志物。
III级。
