Impaired T-Lymphocyte Proliferation Function in Biliary Atresia Patients With Chronic Cholestatic Jaundice After a Kasai Operation

Abstract

ABSTRACT:To investigate the association between chronic cholestatic jaundice, systemic immunity, and various infectious complications in patients with biliary atresia (BA), we performed a survey of the systemic immune function in 30 children with BA. Patients were divided into a jaundice group (total serum bilirubin Ն2 mg/dL for Ͼ6 mo) and control group (total serum bilirubin Ͻ2 mg/dL for Ͼ6 mo) with comparable age. Patients were tested for serum immunoglobulin and complement levels, mitogen response, interleukin (IL)-4, IL-5, and interferon-gamma production after phytohemagglutinin (PHA) stimulation, blood cell and lymphocyte subpopulation counts, phagocytic function, and leukocyte adhesion complex. They were then followed prospectively for 6 mo, and severe infectious complications requiring hospitalization were recorded. Compared with jaundice-free patients, T-lymphocyte proliferation function, determined by PHA mitogen test was significantly lower (p ϭ 0.02) in BA patients with chronic cholestatic jaundice after a Kasai operation. During the study period, patients with chronic cholestatic jaundice had a higher risk of severe infectious complications than their jaundice-free counterparts (risk ratio ϭ 5.87; p ϭ 0.001). In conclusion, BA patients with chronic cholestatic jaundice are associated with impairment of T-lymphocyte proliferation and increased incidence of severe infectious complications.

The correlation between plasma cytokine levels in jaundice-free children with biliary atresia

“…In a cross-sectional study in Taiwan, the median IL-4 level was 3.1 pg/mL (range: 1.6-84.9 pg/mL) in 18 jaundice-free BA children (age range: 1-16.5 years; median: 4.6 years). [21] This may explain why the levels of plasma IL-4 were undetectable in our study. IL-10 can further limit T cells activation and differentiation, leading to suppression of proinflammatory responses and reducing tissue damage from the excessive effects of infl ammation.…”

Inadequate Humoral Immunogenicity to Recombinant Hepatitis B Virus Vaccine in Biliary Atresia Children

“…Impaired T-lymphocyte proliferative function has been demonstrated in cholestatic animal models, and in cholestatic liver diseases such as BA by our previous study (12,17,18). The phenomenon of poor primary immunogenicity to recombinant HBV vaccines in BA patients may partly be due to T-lymphocyte defect which was also observed in patients with end-stage renal disease and AIDS (14,16).…”

“…Impaired T-lymphocyte function among BA patients with jaundice has been demonstrated in our previous study (12). The primary immune response and long-term efficacy of T-lymphocyte dependent HBV vaccine in BA children need to be further investigated.…”

Heme oxygenase system in hepatic ischemia-reperfusion injury

“…The effect of chronic hyperbilirubinemia upon T cell phenotype is unclear, although immunosuppression has been reported in patients with cholestatic jaundice [52] .…”