Immune-mediated liver injury:: prognostic value of CD4+, CD8+, and CD68+ in infants with extrahepatic biliary atresia

Background: Hepatic fibrosis and cirrhosis develop progressively in extrahepatic biliary atresia (EHBA) despite timely surgical intervention. Purpose: The aim of the study was to define CD4(+) helper T lymphocytes, cytotoxic CD8(+) T lymphocytes, and CD68(+) (macrophages) infiltration of portal tracts and lobules and hepatic fibrosis as possible predictive measures of outcome of infants having EHBA. Methods: The outcome of 32 infants with EHBA was con-elated to their percutaneous biopsy and postportoenterostomy core liver tissue infiltration by CD4+, CD68+, and CD8+ cells and to the degree of detected fibrosis. Results: Portoenterostomy cores were heavily infiltrated by CD4+, CD8+, and CD68+, compared with the preoperative liver biopsy (P =.008,.004, and 0.17, respectively). Infants having favorable outcome had more macrophage infiltration in portoenterostomy core compared with those having an unfavorable outcome (25.66 +/- 29.77 per HPF compared with 11.62 +/- 4.58, P =.000). Mean CD4(+)/CD8(+) ratio was 1.54 +/- 1.37 in those who died within 18 months postoperatively and 0.733 +/- 0.48 in others (P=.021). Conclusion: immune-mediated destruction of portal tracts is an integral part of pathogenesis of EHBA. (c) 2005 Elsevier Inc. All rights reserved.