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

Abstract 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 correlated 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 .017, 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.