Inflammation patterns in early post-operative cholangitis predict long-term outcomes in biliary atresia: a potential role of non-suppurative cholangitis.
Biliary atresia
C-reactive protein
Cholangitis
Kasai portoenterostomy
Native liver survival rate
Neutrophil–lymphocyte ratio
Journal
Pediatric surgery international
ISSN: 1437-9813
Titre abrégé: Pediatr Surg Int
Pays: Germany
ID NLM: 8609169
Informations de publication
Date de publication:
16 Jul 2024
16 Jul 2024
Historique:
accepted:
06
07
2024
medline:
16
7
2024
pubmed:
16
7
2024
entrez:
16
7
2024
Statut:
epublish
Résumé
Frequent post-operative cholangitis in biliary atresia (BA) affects the long-term native liver survival. This study assessed the characteristics of early cholangitis and their influence on the prognosis. Forty-three patients with BA who underwent surgery between 2000 and 2020 were analyzed for routine inflammatory markers. Early cholangitis characteristics were compared between native liver survivor (NLS) and living donor liver transplant (LDLT) patients. Among the 43 patients, 30 (69.8%) experienced 130 episodes of cholangitis. In the area under the receiver operating characteristics curve (AUROC) analysis, the cutoff value of the total cholangitis episodes was 3, with an area under the AUROC curve of 0.695 (95% confidence interval 0.522-0.868). Before 3 years old, 113 episodes (86.9%) of cholangitis were observed. The white blood cell, C-reactive protein, and alanine aminotransferase values at cholangitis onset did not markedly differ between the LDLT and NLS groups. Conversely, the neutrophil-to-lymphocyte ratio in the NLS group was significantly lower than in the LDLT group (0.85 vs. 1.63, p < 0.001). Cholangitis in the NLS group was lymphocyte-dominant and atypical in its pathogenesis. Lymphocyte-dominant cholangitis is non-suppurative, and future research should clarify its pathogenesis to improve the treatment and prognosis of BA.
Identifiants
pubmed: 39012391
doi: 10.1007/s00383-024-05774-1
pii: 10.1007/s00383-024-05774-1
doi:
Substances chimiques
Biomarkers
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
190Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Ernest van Heurn LW, Saing H, Tam PK (2003) Cholangitis after hepatic portoenterostomy for biliary atresia: a multivariate analysis of risk factors. J Pediatr 142(5):566–571
doi: 10.1067/mpd.2003.195
pubmed: 12756392
Luo Y, Zheng S (2008) Current concept about postoperative cholangitis in biliary atresia. World J Pediatr 4(1):14–19
doi: 10.1007/s12519-008-0003-0
pubmed: 18402246
Wu ET, Chen HL, Ni YH, Lee PI, Hsu HY, Lai HS, Chang MH (2001) Bacterial cholangitis in patients with biliary atresia: impact on short-term outcome. Pediatr Surg Int 17(5–6):390–395
pubmed: 11527173
Nio M (2017) Japanese Biliary Atresia Registry. Pediatr Surg Int 33(12):1319–1325
doi: 10.1007/s00383-017-4160-x
pubmed: 29039049
Venkat V, Ng VL, Magee JC, Ye W, Hawthorne K, Harpavat S, Molleston JP, Murray KF, Wang KS, Soufi N, Bass LM, Alonso EM, Bezerra JA, Jensen MK, Kamath BM, Loomes KM, Mack CL, Rosenthal P, Shneider BL, Squires RH, Sokol RJ, Karpen SJ, Childhood Liver Disease Research N (2020) Modeling outcomes in children with biliary atresia with native liver after 2 years of age. Hepatol Commun 4(12):1824–1834
doi: 10.1002/hep4.1602
pubmed: 33305153
pmcid: 7706301
Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48(3):452–458
doi: 10.1038/bmt.2012.244
pubmed: 23208313
Chen G, Liu J, Huang Y, Wu Y, Lu X, Dong R, Shen Z, Sun S, Jiang J, Zheng S (2021) Preventive effect of prophylactic intravenous antibiotics against cholangitis in biliary atresia: a randomized controlled trial. Pediatr Surg Int 37(8):1089–1097
doi: 10.1007/s00383-021-04916-z
pubmed: 34013444
Madadi-Sanjani O, Schukfeh N, Uecker M, Eckmann S, Dingemann J, Ure BM, Petersen C, Kuebler JF (2021) The intestinal flora at kasai procedure in children with biliary atresia appears not to affect postoperative cholangitis. Eur J Pediatr Surg 31(1):80–85
doi: 10.1055/s-0040-1715614
pubmed: 32820494
Baek SH, Kang JM, Ihn K, Han SJ, Koh H, Ahn JG (2020) The epidemiology and etiology of cholangitis after kasai portoenterostomy in patients with biliary atresia. J Pediatr Gastroenterol Nutr 70(2):171–177
doi: 10.1097/MPG.0000000000002555
pubmed: 31978011
Cheng K, Molleston JP, Bennett WE Jr (2020) Cholangitis in patients with biliary atresia receiving hepatoportoenterostomy: a national database study. J Pediatr Gastroenterol Nutr 71(4):452–458
doi: 10.1097/MPG.0000000000002836
pubmed: 32639448
Houben C, Phelan S, Davenport M (2006) Late-presenting cholangitis and Roux loop obstruction after Kasai portoenterostomy for biliary atresia. J Pediatr Surg 41(6):1159–1164
doi: 10.1016/j.jpedsurg.2006.01.066
pubmed: 16769353
Ecoffey C, Rothman E, Bernard O, Hadchouel M, Valayer J, Alagille D (1987) Bacterial cholangitis after surgery for biliary atresia. J Pediatr 111(6 Pt 1):824–829
doi: 10.1016/S0022-3476(87)80195-6
pubmed: 3681545
Muraji T, Tsugawa C, Nishijima E, Satoh S, Takamizawa S, Ise K, Maekawa T (2002) Surgical management for intractable cholangitis in biliary atresia. J Pediatr Surg 37(12):1713–1715
doi: 10.1053/jpsu.2002.36703
pubmed: 12483638
Narayanaswamy B, Gonde C, Tredger JM, Hussain M, Vergani D, Davenport M (2007) Serial circulating markers of inflammation in biliary atresia–evolution of the post-operative inflammatory process. Hepatology 46(1):180–187
doi: 10.1002/hep.21701
pubmed: 17596879
Hill R, Quaglia A, Hussain M, Hadzic N, Mieli-Vergani G, Vergani D, Davenport M (2015) Th-17 cells infiltrate the liver in human biliary atresia and are related to surgical outcome. J Pediatr Surg 50(8):1297–1303
doi: 10.1016/j.jpedsurg.2015.02.005
pubmed: 25783388
Yang Y, Liu YJ, Tang ST, Yang L, Yang J, Cao GQ, Zhang JH, Wang XX, Mao YZ (2013) Elevated Th17 cells accompanied by decreased regulatory T cells and cytokine environment in infants with biliary atresia. Pediatr Surg Int 29(12):1249–1260
doi: 10.1007/s00383-013-3421-6
pubmed: 24122073
Harumatsu T, Muraji T, Sugita K, Murakami M, Yano K, Onishi S, Yamada K, Yamada W, Matsukubo M, Kawano T, Muto M, Kaji T, Ieiri S (2022) The preoperative lymphocyte ratio and postoperative C-reactive protein are related to the surgical outcome in biliary atresia: an analysis of serial ubiquitous markers of inflammation. Pediatr Surg Int 38(12):1777–1783
doi: 10.1007/s00383-022-05231-x
pubmed: 36098795
Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS (2008) Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 102(6):653–657
doi: 10.1016/j.amjcard.2008.05.006
pubmed: 18773982
Meng XY, Guo XG, Wang HQ, Pan ZY, Lu YG, Yu WF (2020) Baseline neutrophil-lymphocyte ratio is associated with survival for infant living donor liver transplantation for biliary atresia. Pediatr Transplant e13933
Lorente D, Mateo J, Templeton AJ, Zafeiriou Z, Bianchini D, Ferraldeschi R, Bahl A, Shen L, Su Z, Sartor O, de Bono JS (2015) Baseline neutrophil-lymphocyte ratio (NLR) is associated with survival and response to treatment with second-line chemotherapy for advanced prostate cancer independent of baseline steroid use. Ann Oncol 26(4):750–755
doi: 10.1093/annonc/mdu587
pubmed: 25538172
Rothenberg SS, Schroter GP, Karrer FM, Lilly JR (1989) Cholangitis after the Kasai operation for biliary atresia. J Pediatr Surg 24(8):729–732
doi: 10.1016/S0022-3468(89)80525-1
pubmed: 2769536