Postoperative steroid therapy for biliary atresia: Systematic review and meta-analysis

Chen, Yong; Nah, Shireen Anne; Chiang, Li-Wei; Krishnaswamy, Gita; Low, Ying Min

doi:10.1016/j.jpedsurg.2015.05.016

Cited by 53 publications

(35 citation statements)

References 15 publications

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“…These observations further suggest that anti-inflammatory therapy may not improve native liver survival in the long-term, although corticosteroid therapy seems to promote clearance of jaundice shortly after PE, when the liver displays signs of active inflammation. 26 During cholestasis activated HSCs encircle bile ducts, and periductular myofibroblasts form portal-to-portal fibrotic septa. 12,27 In BA, biliary epithelial cells and cells adjacent to ductal reactions express mesenchymal markers and growth factors consistent with active collagen synthesis, although the origin of these cells forming new bile ductules is unclear.…”

Section: Discussionmentioning

confidence: 99%

Molecular signature of active fibrogenesis prevails in biliary atresia after successful portoenterostomy

Kerola

Lampela

Heikkilä

et al. 2017

Surgery

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Section: Discussionmentioning

confidence: 99%

Molecular signature of active fibrogenesis prevails in biliary atresia after successful portoenterostomy

Kerola

Lampela

Heikkilä

et al. 2017

Surgery

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“…4,[26][27][28] Despite overall improvements in outcomes, the incidence of cholangitis has changed little over time. [29][30][31][32][33][34][35][36] More than 50% of patients (reported to occur between 40 and 93%, this large difference being probably also the result of different diagnostic criteria) after HPE might present one or more episodes of cholangitis 10,37 ; 31% of patients in our series experienced at least one episode of early perioperative cholangitis. Of note, postoperative care changed during the study period (no steroids since 2011), yet incidence of cholangitis did not change over time.…”

Section: Cholangitismentioning

confidence: 99%

Perioperative Complications after Kasai Hepatoportoenterostomy: Data from the Swiss National Biliary Atresia Registry

Calinescu¹,

Wilde²,

Korff

et al. 2019

Eur J Pediatr Surg

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Introduction Hepatoportoenterostomy (HPE) is the first-line treatment for biliary atresia (BA) patients. This study aims to describe perioperative complications after HPE and to analyze their impact on outcome. Materials and Methods Patients with HPE (Swiss National Biliary Atresia Registry, 1994–2017) were retrospectively analyzed. Perioperative complications were defined as complications occurring up to 30 days after surgery. Surgical complications were defined as directly related to the surgical act; medical complications were defined as any other deviation from the uneventful postoperative course. Results Sixty-two patients were included. Median age at HPE was 63 days (18–126). Twenty six patients out of 62 (42%) had ≥ 1 complications: 6/62 (10%) surgical, 24/62 (39%) medical, that is, we observed 7 surgical and 28 medical complications. As for medical complications, cholangitis was the most frequent: 19/28 (68%). Lower gestational age at birth correlated with more overall complications (p = 0.02). Age, weight at HPE, syndromic BA, and postoperative steroid administration were not significantly correlated. There were no perioperative deaths. Perioperative complications did not correlate with overall survival (p = 0.14) and survival with native liver (p = 0.55). Conclusion HPE is often associated with perioperative medical complications. Lower gestational age at birth was significantly associated with more complications. Perioperative complications had no impact on overall outcome.

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“…26 Another important adjuvant therapy is the provision of corticosteroids during the postoperative care period following a Kasai portoenterostomy. The results of randomized controlled trials 3,28,29 and meta-analyses 30,31 have indicated that the administration of moderate-to high-dose steroids is beneficial by increasing the rate of jaundice clearance during the first 6 months after the operation. The majority of those trials found that the elevated rate of jaundice clearance occurred only in patients operated on at a younger age.…”

Section: Discussionmentioning

confidence: 99%

“…Even so, those patients did not demonstrate any improvement in their long-term, native liver survival rates. The meta-analysis by Chen et al 31 also revealed that a longer duration of steroid therapy following the Kasai portoenterostomy failed to elicit any further beneficial outcomes. Our postoperative steroid regimen typically consisted of a low dose of oral prednisolone (2 mg/kg/day), which was tapered by half each week for 4 consecutive weeks; that dosage was provided to 94% of the patients in the current study.…”

Section: Discussionmentioning

confidence: 99%

Factors Related to the Clinical Outcomes of the Kasai Procedure in Infants with Biliary Atresia

Tantemsapya

2020

SMJ

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Objective: The Kasai portoenterostomy has been accepted as the primary therapeutic treatment for biliary atresia. However, successful bile drainage does not always promise a long-term native liver survival. Several clinical factors were evaluated to discover associations with the outcomes. Methods: A retrospective chart review was conducted of infants with biliary atresia who underwent the conventional Kasai portoenterostomy at Siriraj Hospital, January 2006-August 2018. The patient demographics, perioperative clinical and laboratory data, adjuvant therapies, complications, and interventions were analyzed in correlation to the short-and long-term outcomes. The short-term outcome evaluated was the resolution of jaundice, while the long-term outcome was remaining jaundice-free with the native liver. Results: The complete medical records of 80 patients were retrospectively reviewed. Their mean age at the time of the Kasai portoenterostomies was 97 days. Overall, 66.3% achieved jaundice clearance. The mean follow-up duration was 50.5 months, with 51.3% of the patients remaining jaundice-free with their native liver. A prolonged duration of a prophylactic antibiotic was significantly related to the jaundice clearance, with a p-value of 0.002. Moreover, a lower number of episodes of cholangitis was significantly related to a good long-term outcome (p-value, 0.024). Conclusion: The prolonged provision of a prophylactic antibiotic as adjuvant therapy after the Kasai portoenterostomy was associated with jaundice clearance. An increased incidence of cholangitis episodes was associated with poor long-term outcomes. Postoperative adjuvant therapy should be standardized and maintained for the care of biliary atresia patients to improve their outcomes.

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Postoperative steroid therapy for biliary atresia: Systematic review and meta-analysis

Cited by 53 publications

References 15 publications

Molecular signature of active fibrogenesis prevails in biliary atresia after successful portoenterostomy

Molecular signature of active fibrogenesis prevails in biliary atresia after successful portoenterostomy

Perioperative Complications after Kasai Hepatoportoenterostomy: Data from the Swiss National Biliary Atresia Registry

Factors Related to the Clinical Outcomes of the Kasai Procedure in Infants with Biliary Atresia

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