High-dose steroids do not improve early outcome in biliary atresia

Vejchapipat, Paisarn; Passakonnirin, Rojjana; Sookpotarom, Paiboon; Chittmittrapap, Soottiporn; Poovorawan, Yong

doi:10.1016/j.jpedsurg.2007.08.038

Cited by 22 publications

(15 citation statements)

References 27 publications

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“…Five studies were removed based on our exclusion criteria, leaving 2 RCT and 5 OCS for metaanalysis [3,[9][10][11][12][13][14] (Fig. 1; Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The remaining 5 studies applied high doses of steroids in the treatment group. A treatment regimen of prednisolone 4--5 mg/kg/day for 1-2 weeks followed by weeks of tapering dosage was the most commonly used high dose steroid regimen and was adopted by 4 studies [3,[10][11][12]. Two studies used very high dose steroid pulsed therapy with initial doses of methylprednisonone 10 mg/kg/day, which were quickly tapered down to low dose oral steroids over 5-7 days [13,14].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Two studies used very high dose steroid pulsed therapy with initial doses of methylprednisonone 10 mg/kg/day, which were quickly tapered down to low dose oral steroids over 5-7 days [13,14]. The mean age at surgery was below 90 days of life, except for one study [11]. There was no statistical difference when comparing mean age at hepatoenterostomy between steroid and nonsteroid groups among the selected studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

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

Chen¹,

Nah²,

Chiang³

et al. 2015

Journal of Pediatric Surgery

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“…Five studies were removed based on our exclusion criteria, leaving 2 RCT and 5 OCS for metaanalysis [3,[9][10][11][12][13][14] (Fig. 1; Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

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

Chen¹,

Nah²,

Chiang³

et al. 2015

Journal of Pediatric Surgery

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“…The variables studied were associated with the presence or absence of biliary flow, which was defined as a serum bilirubin <2 mg/dL, six months after the surgery (21) .…”

Section: Histopathological Variablesmentioning

confidence: 99%

Multivariate Analysis of Biliary Flow-Related Factors and Post-Kasai Survival in Biliary Atresia Patients

Ferreira

Queiroz

Vidigal

et al. 2019

Arq. Gastroenterol.

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BACKGROUND: Biliary atresia represents the most common surgically treatable cause of cholestasis in newborns. If not corrected, secondary biliary cirrhosis invariably results. OBJECTIVE: To evaluate, through multivariate analysis, the prognostic factors associated with the presence of biliary flow and survival with the native liver following Kasai portoenterostomy. METHODS: The study analyzed data from 117 biliary atresia patients who underwent portoenterostomy and had suitable histological material for evaluation. A logistic regression model was used to assess the presence of biliary flow. Survival was investigated through Kaplan-Meier curves and Cox-adjusted models. RESULTS: One third of patients achieved biliary flow and the median age at surgery was 81 days. Age at surgery, albumin, postoperative complications, biliary atresia structural malformation (BASM), liver architecture, larger duct diameter at porta hepatis, and cirrhosis (Ishak score) were the initial variables for the multivariate analysis. Age at surgery >90 days was the only variable associated with the absence of biliary drainage. Survival analysis revealed that the absence of biliary flow (P<0.0001), age at surgery >90 days (P=0.035), and the presence of BASM (P<0.0001), alone, could predict death or need for liver transplantation. Multivariate analysis demonstrated that the absence of biliary flow (P<0.0001 hazard ratio [HR] 6.25, 95% confidence interval [CI] 3.19-12.22) and the presence of BASM (P=0.014 HR 2.16, 95% CI 1.17-3.99) were associated with lowest survival with the native liver. CONCLUSION: Age at surgery >90 days was associated with absence of biliary flow. The presence of biliary drainage and the absence of structural malformations are cornerstone features for higher survival rates with the native liver.

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“…Other strategies to improve post-KP native liver survival, mostly directed toward postoperative patient care management, include the use of prophylactic antibiotics to prevent recurrent cholangitis, the addition of choleretic agents such as ursodeoxycholic acid to stimulate bile flow and the initiation of aggressive nutritional support to enhance growth (8). Whether corticosteroids, because of their putative anti-inflammatory, immunomodulatory and choleretic properties, further improve the outcome for BA patients post-KP remains controversial despite the many observational studies over the past several decades (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). The aim of the present study was to systematically review the literature and, using a metaanalysis, determine the efficacy of adjuvant postoperative steroid therapy on the outcome of KP in patients with BA.…”

mentioning

confidence: 99%

Does Adjuvant Steroid Therapy Post-Kasai Portoenterostomy Improve the Outcome of Biliary Atresia? A Systematic Review and Meta-Analysis

Sarkhy

Schreiber²,

Milner³

et al. 2011

Canadian Journal of Gastroenterology

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The present meta-analysis did not find a significant effect of steroid over standard therapy, either in normalizing serum bilirubin levels at six months or at delaying the need for early liver transplantation post-KP. RCT studies of sufficient size and comprehensive design using high-dose steroids are needed to determine the effectiveness of steroids on the short and intermediate post-KP outcomes for BA patients.

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High-dose steroids do not improve early outcome in biliary atresia

Cited by 22 publications

References 27 publications

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

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

Multivariate Analysis of Biliary Flow-Related Factors and Post-Kasai Survival in Biliary Atresia Patients

Does Adjuvant Steroid Therapy Post-Kasai Portoenterostomy Improve the Outcome of Biliary Atresia? A Systematic Review and Meta-Analysis

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