Background: Hepatic fibrosis and cirrhosis develop progressively in extrahepat ic biliary atresia (EHBA) despite timely surgical intervention. Purpose: The aim of the study was to define CD4+helper T lymphocytes, cytotoxic CD8+T lymphocy tes, and CD68+(macrophages) infiltration of portal tracts and lobules and hepat ic fibrosis as possible predictive measures of outcome of infants having EHBA. M ethods: The outcome of 32 infants with EHBA was correlated to their percutaneous biopsy and postportoenterostomy core liver tissue infiltration by CD4+, CD68+ , and CD8+cells and to the degree of detected fibrosis. Results: Portoenterosto my cores were heavily infiltrated by CD4 +, CD8+, and CD68+, compared with th e preoperative liver biopsy (P = .008, .004, and .017, respectively). Infants ha ving favorable outcome had more macrophage infiltration in portoenterostomy core compared with those having an unfavorable outcome (25.66 ±29.77 per HPF compar ed with 11.62 ±4.58, P = .000). Mean CD4+/CD8 +ratio was 1.54 ±1.37 in those who died within 18 months postoperatively and 0.733 ±0.48 in others (P = .021) . Conclusion: Immune-mediated destruction of portal tracts is an integral part of pathogenesis of EHBA.
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