Inflammation patterns in early post-operative cholangitis predict long-term outcomes in biliary atresia: a potential role of non-suppurative cholangitis
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In brief
In brief
Study of 43 biliary atresia patients reveals that lymphocyte-dominant cholangitis patterns in early post-operative period predict better native liver survival compared to neutrophil-dominant inflammation. Patients requiring liver transplant showed significantly higher neutrophil-to-lymphocyte ratios during cholangitis episodes, suggesting distinct inflammatory pathways may influence long-term outcomes.
- Frequent post-operative cholangitis in biliary atresia significantly impacts long-term native liver survival outcomes.
- 86.9% of cholangitis episodes occur before age 3; more than 3 total episodes predicts worse prognosis (AUROC 0.695).
- Native liver survivors show lymphocyte-dominant (non-suppurative) cholangitis vs. neutrophil-dominant in transplant patients.
- Neutrophil-to-lymphocyte ratio distinguishes inflammation patterns: NLS group 0.85 vs. LDLT group 1.63 (p<0.001).
- Non-suppurative cholangitis may represent distinct pathogenesis requiring targeted treatment strategies in biliary atresia.
Written by the GCMD Library team from the article.
Abstract
Purpose
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.
Methods
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.
Results
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).
Conclusions
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.