Open AccessThe Fecal Microbiome in Infants With Biliary Atresia Associates With Bile Flow After Kasai Portoenterostomy
Author(s) -
Tessier Mary Elizabeth M.,
Cavallo Laurel,
Yeh Jennifer,
Harpavat Sanjiv,
Hoffman Kristi L.,
Petrosino Joseph F.,
Shneider Benjamin L.
Publication year - 2020
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000002686
Subject(s) - biliary atresia , cholestasis , medicine , microbiome , gastroenterology , neonatal cholestasis , bile acid , feces , bifidobacterium , bacteroides , liver transplantation , food science , transplantation , biology , bioinformatics , microbiology and biotechnology , bacteria , genetics , fermentation , lactobacillus
ABSTRACT Background: Biliary atresia's (BA) response to surgical Kasai portoenterostomy (KP) is uneven and dependent upon bile flow; 50% of infants require a liver transplant by 24 months. We hypothesized that the microbiome may identify and associate with outcomes in BA. Methods: Stool samples were collected from infants with cholestasis (n = 15), 8 of which with BA were followed longitudinally.16S sequencing was performed on all samples (n = 45). Whole Genome Sequencing (WGS) was performed on BA pre‐KP samples (n = 8). Infants with BA, other forms of cholestasis, BA infants with very good bile flow (VGBF) and not (nVGBF) (VGBF dichotomized by TSBA <40 μmol/L by 6 months) were compared. Results: Of the 8 infants with BA, 4 infants had VGBF. Microbial richness was inversely proportional to degree of cholestasis ( P = 0.046). Increased Bifidobacterium abundance associated with VGBF ( P = 0.03) and decreased cholestasis ( P < 0.01) at 1 month post‐KP. Pre‐KP, community structure differed in infants with BA versus other cholestasis. Interestingly, infants who subsequently achieved VGBF had increased diversity ( P = 0.03) and different community structure at the pre‐KP time point. WGS corroborated Bifidobacterium's pre‐KP importance. Conclusions: The microbiome differs between infants with BA and other cholestasis. It additionally differs between infants with BA who have good and poor bile flow, and thus outcomes, post‐KP. These differences are seen even before KP. These data suggest that bile influences the development of the infant microbiome and that there may be possible influences of the pre‐ and post‐KP microbiome on bile flow after KP. Further larger studies are needed to confirm these findings.