L'espressione della Citocheratina 20 (CK20) nell'atresia delle vie biliari: un nuovo possibile marker di prognosi

Background The aetiology and the prognostic factors of biliary atresia (BA), a progressive obstructive cholangiopathy of infants, are still not well known. Four different subtypes of BA have been described in relation to the age of the developmental failure during gestational age (i.e. Biliary Atresia Splenic Malformation (BASM), Cystic BA, CMV IgM +ve BA and Isolated BA). We aimed to investigate the relation between the bile duct damage in the porta hepatis and liver and cells with an intestinal phenotype (expressing Cytokeratin 20 (CK-20)) in order to establish if this could be considered a prognostic marker of BA. Methods Samples were orientated intra-operatively then immunostained with anti-cytokeratin 20 (CK20). Sections were then digitised and analysed. Clinical and immunohistochemical data were compared. Data are quoted as median (range). Non-parametric statistical comparisons were made as appropriate. P < 0.05 was regarded as significant. Results 48 consecutive infants were treated with Kasai Portoenterostomy (KPE) or primary liver transplantation in a single-centre between 1999 and 2017. CK20 expression in the liver was not associated with a successful KPE (P = 0.69) or native liver survival (P = 0.91). By contrast, remnant porta hepatis CK20 expression was associated with a successful KPE (P=0.04, HR: 0.49). Diffuse expression (distribution > 50% of slide) was associated with a longer period of native live survival (P=0.01; HR: 0.29). Conclusions CK20 diffuse expression in the porta hepatis is associated with a successful KPE and it is a predictor of native liver survival.