Author Affiliations: Department of Pediatric Surgery, Children's Hospital, Medical Centre of Fudan University, Shanghai 200032, China (Shen C, Zheng S, Wang W, Xiao XM)

Corresponding Author: Shan Zheng, MD, Children's Hospital of Fudan University, Shanghai 200032, China (Tel: 86-21-54524666 ext 2042; Fax: 86-21-64038992; Email: szheng@shmu.edu.cn)

Background: The etiology of biliary atresia is still unknown. It is generally accepted that virus infection may be one of the important causes that lead to biliary atresia. This study aimed to illustrate the relationship between infection of cytomegalovirus and prognosis of biliary atresia. 

Methods: From January 2002 to March 2004, 27 patients who had undergone Kasai's procedure because of biliary atresia were investigated for cytomegalovirus -IgG, IgM and pp65, and their mothers were also examined for confirmation of cytomegalovirus infection. The patients were divided into three groups: infection free group, cytomegalovirus positive group and cytomegalovirus infection group. The rate of jaundice disappearance and the incidence of reflux cholangitis were analyzed statistically. The histopathological changes of the liver were also analyzed.

Results: The positive expression of cytomegalovirus -IgM and cytomegalovirus-pp65 in the patients was higher than that in their mothers (48% versus 14.81% and 37% versus 3.78%, respectively). Compared with the other two groups (80% in the infection free group, and 82% in the cytomegalovirus positive group), the rate of jaundice disappearance after operation in the cytomegalovirus infection group (36%) was significantly lower (P<0.05), and the incidence of reflux cholangitis was higher (P<0.05). Histopathological examination also showed that the degree of liver fibrosis and inflammation was more serious (P<0.05).

Conclusions: There is a strong correlation between cytomegalovirus infection and a lower rate of jaundice disappearance, also a higher post-operational reflux cholangitis. Liver fibrosis seems to be more severe in biliary atresia patients with cytomegalovirus infection.

Key words: biliary atresia; cytomegalovirus; prognosis

World J Pediatr 2008;4(2):123-126