Proliferation of intrahepatic bile-duct epithelium in biliary atresia - A useful predictor of clinical outcome

Proliferating cell nuclear antigen (PCNA) and transforming growth factor alpha (TGF alpha) are considered as markers of cell proliferation. The expression of PCNA and TGF alpha was evaluated immunohistochemically using anti-PCNA antibody and TGF alpha in 31 patients with biliary atresia (BA) (15 jaundice-free and 16 with persistent jaundice) and 6 control infants. The labeling indices (LI) for PCNA- and TGF alpha-positive bile-duct epithelium in BA were 14.1+/-14.0% and 51.4+/-33.7%, respectively, which was significantly higher than in the controls (P<0.01). In BA, the number of PCNA-immunoreactive cells was higher in the peripheral bile ductules than in the central bile ducts of the portal tract (P<0.01). LI was not related to patient age at the time of hepatic portoenterostomy in two groups divided at the age of 60 days. Patients in the persistent jaundice group had greater expression of PCNA and TGF alpha (21.7+/-16.0% and 76.9+/-20.7%, respectively) compared to those in the jaundice-free group (6.0+/-2.7% and 24.3+/-20.9%, P<0.001). PCNA and TGF alpha expression in the bile-duct epithelium of the portal tract was closely related to prognosis in BA patients, and thus could be useful as a prognostic marker.