Postoperative corticosteroid therapy for bile drainage in biliary atresia—a nationwide survey

Randomized, double-blind, placebo-controlled trial of corticosteroids after Kasai portoenterostomy for biliary atresia

“…13 Early commencement in the first week after the operation appears unpopular and is not recommended. 16 However, little actual evidence has been published, 4,14,16 and certainly no prospective comparison has been published. Kobayashi et al 4 retrospectively reviewed 5 different regimens (including no steroids) in a series of 63 cases from 1 Tokyo center, but they found no difference except in 1, which consisted of an initial daily dose of 20 mg of prednisolone given for a variable period dictated by changes in the stool color.…”

“…30,31 The suggested dose and duration of adjuvant steroids have varied over the past 20 years, with the highest dose regimen consisting of a starting dose of 10 mg/kg/day of intravenous methyl prednisolone tapered to day 5 and continuing with oral prednisone at 2 mg/kg/ day for 12 weeks after the operation. 3 Regimens of this nature constitute a severe risk of adrenal suppression and other dose-related side effects, although it is important to point out that, aside from a possible case of cytomegalovirus meningitis, 16 no adverse effects have actually been reported in the studies to date. Nonetheless, there are some cautionary parallels with the use of steroids in premature infants in an attempt to prevent chronic lung disease.…”

Corticosteroid treatment in biliary atresia: Tonic or toast?

“…The extent of use of steroid therapy in BA was quantified in 2002-2003 by a nationwide survey in Japan. 21 Among 54 institutions responding to the survey, only 2 did not use steroids, it was used routinely for every patient in 43 and used selectively at 9 centers. From 1997 to 2000, 208 patients with type III BA received steroids, and only 14 did not.…”

“…In fact, few if any adverse events have been reported in the many published reports, and this is not unexpected given the retrospective nature of the data collection. In the Japanese national survey, 21 five complications were reported, including wound dehiscence, gastrointestinal hemorrhage and perforation, anastomotic failure, and candida infection. However, this report also lacked an adequate control group, so causation cannot be accurately assessed.…”

80. Dexamethasone Alters the Hepatic Inflammatory Cellular Profile Without Changes in Matrix Degradation During Liver Repair Following Biliary Decompression

“…The use of steroids has become an almost universal part of the management of post Kasai cholangitis. (10,(11)(12)(13)(14) Due to the success of liberal steroid use in many early and subsequent studies of cholangitis, their potential application for all patients with biliary atresia has been proposed and even tested in a limited trial. They are hypothesized to suppress the immunologic attack on intrahepatic biliary epithelia, depress the secondary inflammatory cascade, and promote bile flow.…”