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. 2022 Dec 1;117(12):2075-2078.
doi: 10.14309/ajg.0000000000001985. Epub 2022 Sep 1.

Longitudinal Assessment of Bile Duct Loss in Primary Biliary Cholangitis

Julian Hercun  1 , Mazen Noureddin  1 , Nabil Noureddin  1 , Jason Eccleston  1 , Daniel Woolridge  1 , T Jake Liang  1 , Michele Tana  1 , David E Kleiner  2 , Gracia Viana Rodriguez  1 , Christopher Koh  1 , Jay H Hoofnagle  1 , Theo Heller  1
Affiliations

Longitudinal Assessment of Bile Duct Loss in Primary Biliary Cholangitis

Julian Hercun et al. Am J Gastroenterol. .

Abstract

Introduction: Bile duct involvement is a key finding of primary biliary cholangitis (PBC). The aim of this study was to evaluate baseline ductopenia and disease progression.

Methods: Retrospective longitudinal histological follow-up of treatment-naive patients with PBC.

Results: Eighty-three patients were included, with ductopenia correlated to fibrosis stage at baseline. The cumulative incidence of severe ductopenia remained stable after 5 years, whereas fibrosis continually increased over time. Baseline AST-to-Platelet Ratio Index and elevated alkaline phosphatase >2 times the normal with abnormal bilirubin were associated with ductopenia progression.

Discussion: Bile duct injury does not seem to follow the same course as fibrosis in PBC.

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Conflict of interest statement

Potential competing interests: The authors conducted this work as employees of the National Institutes of Health and have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Progression of Ductopenia. A, C. The initial biopsy showed inflamed portal areas with duct injury. (Panel A, H&E, 400x), while keratin 7 staining shows positive staining in periportal hepatocytes (Panel C, anti-keratin 7, 200x). B, D. A second biopsy obtained four years later shows ductopenic portal areas. (Panel B, H&E, 400x) and the keratin 7 stain shows ductular reaction and more extensive hepatocyte staining (Panel D, anti-keratin 7, 200x).
Figure 2.
Figure 2.
Kaplan Meier analysis of progression of ductopenia. (A) Progression to severe ductopenia (<25%) stratified by initial ductopenia score 0 or 1 (>50% bile ducts) in red and initial ductopenia score 2+ (25 to 50%) in blue, (B) progression to severe ductopenia stratified by baseline elevated baseline APRI in blue, (C) overall decrease in bile duct count from first biopsy on final biopsy stratified by baseline elevated APRI in blue and (D) progression to severe ductopenia with baseline ALP > 2 times the upper limit of normal with an elevated bilirubin in blue. P value log rank score.
See this image and copyright information in PMC

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