Preoperative Serum IL-12p40 Is a Potential Predictor of Kasai Portoenterostomy Outcome in Infants with Biliary Atresia

Goda, S. S.; Khedr, Mohamed Ahmed; El-Shenawy, Soha Z.; Ibrahim, T.; El-Araby, Hanaa Ahmed; Sira, Mostafa Mohamed

doi:10.1155/2017/9089068

Cited by 6 publications

(2 citation statements)

References 39 publications

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“…Specifically, IL-8 leads to bile duct injury, and decreased NLSR is associated with elevated circulating IL-8 levels at two months post Kasai [ 73 ]. Contrastingly, IL-12p40 or IL-12B, activate natural killer cells in proinflammatory cytokine IL-12p70, and this process is hypothesized to predict NLSR at Kasai [ 74 75 ].…”

Section: Discussionmentioning

confidence: 99%

Peri-Operative Liver Fibrosis and Native Liver Survival in Pediatric Patients with Biliary Atresia: A Systematic Review and Meta-Analysis

Jahangirnia

Oltean

Nasr

et al. 2022

Pediatr Gastroenterol Hepatol Nutr

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No systematic review to date has examined histopathological parameters in relation to native liver survival in children who undergo the Kasai operation for biliary atresia (BA). A systematic review and meta-analysis is presented, comparing the frequency of native liver survival in peri-operative severe vs. non-severe liver fibrosis cases, in addition to other reported histopathology parameters. Records were sourced from MEDLINE, Embase, and CENTRAL databases. Studies followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and compared native liver survival frequencies in pediatric patients with evidence of severe vs. non-severe liver fibrosis, bile duct proliferation, cholestasis, lobular inflammation, portal inflammation, and giant cell transformation on peri-operative biopsies. The primary outcome was the frequency of native liver survival. A random effects meta-analysis was used. Twenty-eight observational studies were included, 1,171 pediatric patients with BA of whom 631 survived with their native liver. Lower odds of native liver survival in the severe liver fibrosis vs. non-severe liver fibrosis groups were reported (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.08–0.33; I 2 =46%). No difference in the odds of native liver survival in the severe bile duct destruction vs. non-severe bile duct destruction groups were reported (OR, 0.17; 95% CI, 0.00–63.63; I 2 =96%). Lower odds of native liver survival were documented in the severe cholestasis vs. non-severe cholestasis (OR, 0.10; 95% CI, 0.01–0.73; I 2 =80%) and severe lobular inflammation vs. non-severe lobular inflammation groups (OR, 0.02; 95% CI, 0.00–0.62; I 2 =69%). There was no difference in the odds of native liver survival in the severe portal inflammation vs. non-severe portal inflammation groups (OR, 0.03; 95% CI, 0.00–3.22; I 2 =86%) or between the severe giant cell transformation vs. non-severe giant cell transformation groups (OR, 0.15; 95% CI, 0.00–175.21; I 2 =94%). The meta-analysis loosely suggests that the presence of severe liver fibrosis, cholestasis, and lobular inflammation are associated with lower odds of native liver survival in pediatric patients after Kasai.

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Section: Discussionmentioning

confidence: 99%

Peri-Operative Liver Fibrosis and Native Liver Survival in Pediatric Patients with Biliary Atresia: A Systematic Review and Meta-Analysis

Jahangirnia

Oltean

Nasr

et al. 2022

Pediatr Gastroenterol Hepatol Nutr

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“…Schneider et al, for example, suggested that failure to normalize serum bilirubin within three months after Kasai should elicit prompt evaluation for LT as extended native liver survival is exceptional among these patients [50]. Moreover, though a "Kasai success predicting score" remains far from reality, other groups support more research in that direction as part of BA management-a strategy that would allow early primary transplantation [47,54,[57][58][59][60][61].…”

Section: Steadily Increasing Prioritization Requestsmentioning

confidence: 99%

Variability of Care and Access to Transplantation for Children with Biliary Atresia Who Need a Liver Replacement

Goyet

Illhardt

Chardot³

et al. 2022

JCM

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Background & Aims: Biliary atresia (BA) is the commonest single etiology indication for liver replacement in children. As timely access to liver transplantation (LT) remains challenging for small BA children (with prolonged waiting time being associated with clinical deterioration leading to both preventable pre- and post-transplant morbidity and mortality), the care pathway of BA children in need of LT was analyzed—from diagnosis to LT—with particular attention to referral patterns, timing of referral, waiting list dynamics and need for medical assistance before LT. Methods: International multicentric retrospective study. Intent-to-transplant study analyzing BA children who had indication for LT early in life (aged < 3 years at the time of assessment), over the last 5 years (2016–2020). Clinical and laboratory data of 219 BA children were collected from 8 transplant centers (6 in Europe and 2 in USA). Results: 39 patients underwent primary transplants. Children who underwent Kasai in a specialist -but not transplant- center were older at time of referral and at transplant. At assessment for LT, the vast majority of children already were experiencing complication of cirrhosis, and the majority of children needed medical assistance (nutritional support, hospitalization, transfusion of albumin or blood) while waiting for transplantation. Severe worsening of the clinical condition led to the need for requesting a priority status (i.e., Peld Score exception or similar) for timely graft allocation for 76 children, overall (35%). Conclusions: As LT currently results in BA patient survival exceeding 95% in many expert LT centers, the paradigm for BA management optimization and survival have currently shifted to the pre-LT management. The creation of networks dedicated to the timely referral to a pediatric transplant center and possibly centralization of care should be considered, in combination with implementing all different graft type surgeries in specialist centers (including split and living donor LTs) to achieve timely LT in this vulnerable population.

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Predicting native liver injury and survival in biliary atresia

Hukkinen

Pihlajoki

Pakarinen

2020

Seminars in Pediatric Surgery

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Preoperative Serum IL-12p40 Is a Potential Predictor of Kasai Portoenterostomy Outcome in Infants with Biliary Atresia

Cited by 6 publications

References 39 publications

Peri-Operative Liver Fibrosis and Native Liver Survival in Pediatric Patients with Biliary Atresia: A Systematic Review and Meta-Analysis

Peri-Operative Liver Fibrosis and Native Liver Survival in Pediatric Patients with Biliary Atresia: A Systematic Review and Meta-Analysis

Variability of Care and Access to Transplantation for Children with Biliary Atresia Who Need a Liver Replacement

Predicting native liver injury and survival in biliary atresia

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