Prognostic factors of histopathological findings for liver cirrhosis in biliary

atresia patients following Kasai procedure

Dian Nirmala Sirait1, Leila Rakhma Budiarti1, Akhmad Makhmudi1, Hanggoro Tri
Rinonce2, Gunadi1

1Pediatric Surgery Division, Department of Surgery, Faculty of Medicine Universitas Gadjah

Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
2Department of Anatomical Pathology, Faculty of Medicine Universitas Gadjah Mada/Dr. Sardjito
Hospital, Yogyakarta 55281, Indonesia

Abstract
Purpose: Biliary atresia (BA), characterized by fibroinflammatory obliteration of
extrahepatic biliary tree, is most common cause of cholestasis in neonates. Many
histopathological studies of BA have been reported over the world. However, there is a
great paucity of knowledge about BA histopathology in South East Asia. We aimed to
describe hepatic histopathological findings and associate them with incidence of
cirrhosis in Indonesian BA patients.
Methods: We reviewed histopathology of BA patients underwent Kasai procedure
from August 2012 to September 2016 at Dr. Sardjito Hospital, Indonesia.
Results: We involved 25 BA patients of whom 15 and 10 were males and females,
respectively. The mean age at Kasai procedure was 118  57 days (range, 52 – 268 days).
There were 14 (56%) and 11 (44%) BA patients with and without cirrhosis, respectively.
Portal fibrosis, bile duct proliferation, and cholestasis showed a strong association with
cirrhosis (p<0.001), but portal inflammation and giant cell transformation did not. The
BA patients with severe bile duct proliferation were 58-fold having cirrhosis than those
with mild/moderate bile duct proliferation (p<0.001), while the BA patients with severe
cholestasis were 60-fold suffering cirrhosis than those with absent/mild/moderate
cholestasis (p<0.001). Although not statistically significant (p=0.21), the patients with
severe portal inflammation tend to get cirrhosis 4.5-fold than those with mild/moderate
portal inflammation.
Conclusions: There is a significant association between portal fibrosis, bile duct
proliferation, and cholestasis with cirrhosis in Indonesian BA patients. The high
incidence of cirrhosis among BA patients might imply the necessity of early diagnosis of
BA.