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MO3.8 Liver nodules in biliary atresia patients

Ana M. Calinescu, Switzerland

University Hospitals of Geneva


Liver nodules in biliary atresia patients

Ana Calinescu1, Mehrak Anooshiravani-Dumont3, Anne L. Rougemont4, Margot Szabo1, Nathalie Rock2, Valérie A. McLin2, Barbara E. Wildhaber1.

1Pediatrics, Division of Pediatric Surgery, Geneva University Hospitals, Geneva, Switzerland; 2Pediatics, Division of Pediatric Hepatology, Gastroenterology and Nutrition, Geneva University Hospitals, Geneva, Switzerland; 3Pediatrics, Division of Pediatric Radiology, Geneva University Hospitals, Geneva, Switzerland; 4Pathology and Immunology, Division of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland

Introduction: In patients with biliary atresia (BA) liver nodules can be identified either by pre-transplant imaging or on the explant. The aim of the present study was to analyse the histopathology of liver nodules identified on explants. The secondary aim was to correlate histological findings with the radiologic features.
Method: Liver nodules in liver explants of BA patients transplanted in our center (2000-2020) were retrospectively analysed. Correlations with preoperative radiological characteristics, patient age at liver transplantation (LT), time from Kasai to LT, age at Kasai and Kasai success (defined as conjugated bilirubin < 20 mmol/l at 6 months) were sought. All patients underwent pre-LT CT-scan and/or ultrasound (US). Fisher exact test and t-test were employed for the statistical analysis. Ethics committee approval: CE06-050.
Results: Sixty-two BA-patients were included in the analysis. 29/62 (47 %) patients had 34 liver nodules on explants (two patients had 3 types of nodules and one patient 2 types of nodules). The identified nodules were benign in 25/34 (74%): 14 regenerative nodules, 4 cholestatic nodules, 3 steatosis nodules, 1 cirrhotic nodule, 1 fibrosis nodule, 1 biliary infarction nodule and 1 focal nodular hyperplasia. Nine (9/34-26%) nodules were malignant or pre-malignant: 2 were consistent with hepatocellular carcinoma, 4 nodules displayed high-grade dysplasia, 1 low-grade dysplasia, 1 small cell dysplasia, and 1 cholestatic dysplastic nodule. On pre-LT imaging, only 9/62 (14.5%) patients had identified liver nodules (p<0.01); none were considered malignant. The occurrence of liver nodules correlates with patient age at LT (p=0.001) and time interval between Kasai and LT (p=0.03). There was a significant direct correlation between successful Kasai and liver nodules (p=0.003). 
Conclusion: Liver nodules were frequently encountered in explanted livers after Kasai. A high proportion was not detected radiologically. The following factors were predictive of nodules on the explant: older age at LT, longer time interval from Kasai to LT, or the presence of a successful Kasai. One quarter of the lesions was malignant or pre-malignant, emphasizing the need for careful surveillance of BA patients after Kasai

Presentations by Ana M. Calinescu