IMMUNOHISTOCHEMICAL STUDY OF PROLIFERATING CELL NUCLEAR ANTIGEN IN HEPATOCYTES OF BILIARY ATRESIA - A PARAMETER TO PREDICT CLINICAL OUTCOME

The hepatic lobulus was studied histologically and immunohistochemical ly using the monoclonal antibody for proliferating cell nuclear antige n (PCNA/Cyclin, a cell-cycle-related nuclear protein) in 27 patients w ith biliary atresia (BA) and six normal infants. The study showed that the labeling index (LI) for PCNA-positive hepatocytes was 37.21 +/- 1 7.75% in the patients with BA and 3.14 +/- 1.5% in the normal infants (P < .0001). LI for PCNA-positive cells was higher in the periportal a rea than the pericentral area (P < .01). LI was not related to the pat ients' age at the time of hepatic portoenterostomy. LI was 20.80 +/- 7 .03% for patients whose jaundice cleared postoperatively and 48.49 +/- 13.43% for patients who had persistent jaundice (P < .001). Conventio nal histological studies of the same specimens showed common findings of BA, such as hepatocellular degeneration, necrosis, inflammatory cel l infiltration, and giant cell transformation. Most patients with BA h ad 8.94 +/- 13.55% giant cell transformation among 1.000 hepatocytes. Patients who exhibited high giant cell transformation had an unfavorab le outcome. Only 0.42% of giant cells were immunoreactive for PCNA. In conclusion, the PCNA expression of hepatocytes is closely related to the prognosis of patients with BA, and thus could be used as a prognos tic indicator. Copyright (C) 1995 by W.B. Saunders Company.