Ten-Year Experience in the Prevention of Post-Kasai Cholangitis

Pang, Wenbo; Zhang, Tingchong; Chen, Yajun; Peng, Chunhui; Wang, Zengmeng; Wu, Dongyang; Wang, Kai

doi:10.1089/sur.2018.047

Cited by 9 publications

(8 citation statements)

References 22 publications

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“…It has reported that varies regimes for prevention of cholangitis in patients with BA after KPE, prophylactic antibiotics after KPE to reduce the incidence of cholangitis is universal, but few published studies provide satisfactory evidence for its benefit [11] . furthermore, the latest research, Wen Bo Pang et al reported that prophylactic imipenem-cilastatin and human immunoglobulin is effectively on the prevention of early-onset cholangitis (12). Although the use of steroids plays active role in bile flow after Kasai procedures, there was no evidence that it plays any role on prevention of cholangitis.…”

Section: Discussionmentioning

confidence: 99%

Intravenous antibiotics for the treatments of cholangitis after Kasai operation in biliary atresia patients

Wang¹,

Li²,

Jiao³

et al. 2020

Preprint

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Objective: This is a single-center, retrospective study, to assess the experimental treatment of intravenous antibiotics for cholangitis after Kasai portoenterostomy (PKE) in biliary atresia (BA) patients.Methods: 153 cholangitis patients after PKE from January 2016 to December 2018 were retrospectively reviewed. Based on the different kinds of antibiotics treatment, all patients were divided into 3 groups: Intravenous Cefoperazone Sodium Tazobactam Sodium (ICSTS) group, Intravenous Meropenem (IMP) group, Meropenem combined with Intravenous immunoglobulin (IVIG) group, compared the tre atment effect among 3 groups.Results: The recurrent cholangitis rate of ICSTS group, IMP group and IVIG group is 28.9%,39.4%, 85.7% respectively. The IVIG group had higher temperature (T), white blood cell (WBC), C-reactive protein (CRP), alanine transaminase (ALT) and aspartate transaminase (AST) lever than ICSTS group and IMP group (P <0.05) before interference. The antifebrile rate had no significant difference among 3 groups after 3 days hospitalization, as we expected, the level of WBC, CRP, DBL was significant descend in each group, the level of ALT, AST, γ-GGT was obviously decline in IVIG group. After 3 months followed-up, IVIG group showed a recurrent rate of 82%, which was higher than ICSTS group and IMP group (P=0.013), the cholangitis frequency was significant higher in IVIG group than ICSTS group and IMP group (P<0.05).Conclusions: Personalized intravenous antibiotics to treat cholangitis considering recurrent episode, the severity of infection and liver function, may be a more appropriate treatment strategy.

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Section: Discussionmentioning

confidence: 99%

Intravenous antibiotics for the treatments of cholangitis after Kasai operation in biliary atresia patients

Wang¹,

Li²,

Jiao³

et al. 2020

Preprint

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“…We excluded participants with known immunodeficiency, known viral infection, an identified source of infection other than cholangitis, end-stage liver failure, hemolytic jaundice, known allergies, or other contraindications to the use of IVIG, cefoperazone sodium tazobactam sodium (CSTS) and MEPM, a history of cholangitis unresponsive to CSTS, unstable conditions and sepsis-related organ damage, other liver disease or severe comorbidities requiring surgical intervention 11 .…”

Section: Methodsmentioning

confidence: 99%

“…However, the efficacy of cefoperazone has decreased over the years 10 . In many institutions, meropenem (MEPM) has been proven to be an effective antibiotic 7 , 11 , 12 . Recently, intravenous immunoglobulin (IVIG) has shown promising results as an effective adjunctive treatment for refractory post-KPE cholangitis 11 , 13 .…”

Section: Introductionmentioning

confidence: 99%

Severity assessment to guide empiric antibiotic therapy for cholangitis in children after Kasai portoenterostomy: a multicenter prospective randomized control trial in China

Wang,

Zhang,

Yang

et al. 2023

International Journal of Surgery

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Background: Cholangitis is common in patients with biliary atresia following Kasai portoenterostomy (KPE). The prompt use of empiric antibiotics is essential due to the lack of identified microorganisms. The authors aimed to validate a severity grading system to guide empiric antibiotic therapy in the management of post-KPE cholangitis. Materials and methods: This multicenter, prospective, randomized, open-label study recruited patients with post-KPE cholangitis and was conducted from January 2018 to December 2019. On admission, patients were categorized into mild, moderate, and severe cholangitis according to the severity grading system. Patients in the mild cholangitis group were randomized to receive cefoperazone sodium tazobactam sodium (CSTS) or meropenem (MEPM). Patients with severe cholangitis were randomized to treatment with MEPM or a combination of MEPM plus immunoglobulin (MEPM+IVIG). Patients with moderate cholangitis received MEPM. Results: The primary endpoint was duration of fever (DOF). Secondary outcomes included blood culture, length of hospital stay, incidence of recurrent cholangitis, jaundice clearance rate, and native liver survival (NLS). For mild cholangitis, DOF, and length of hospital stay were similar between those treated with CSTS or MEPM (all P>0.05). In addition, no significant difference in recurrence rate, jaundice clearance rate, and NLS was observed between patients treated with CSTS and MEPM at 1-month, 3-month, and 6-month follow-up. In patients with moderate cholangitis, the DOF was 36.00 (interquartile range: 24.00–48.00) h. In severe cholangitis, compared with MEPM, MEPM+IVIG decreased DOF and improved liver function by reducing alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and direct bilirubin at 1-month follow-up. However, recurrence rate, jaundice clearance rate, and NLS did not differ significantly between MEPM+IVIG and MEPM at 1-month, 3-month, and 6-month follow-up. Conclusions: In patients with post-KPE cholangitis, MEPM is not superior to CSTS for the treatment of mild cholangitis. However, MEPM+IVIG treatment was associated with better short-term clinical outcomes in patients with severe cholangitis.

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“…However, prophylaxis must be balanced against the possibility of lethal cholangitis secondary to resistant organisms [4]. This said, it is almost impossible to compare the existing body of literature due to the wide variety in practices of cholangitis prophylaxis and, again, the lack of a unanimous thus comparable definition of cholangitis [5,19].…”

Section: Introductionmentioning

confidence: 99%

Cholangitis Definition and Treatment after Kasai Hepatoportoenterostomy for Biliary Atresia: A Delphi Process and International Expert Panel

Calinescu

Madadi-Sanjani

Mack

et al. 2022

JCM

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(1) Background: Acute cholangitis during the first year after Kasai hepatoportoenterostomy (HPE) has a negative impact on patient and native liver survival. There are no consistent guidelines for the definition, treatment, and prophylaxis of cholangitis after HPE. The aim of this study was to develop definition, treatment, and prophylaxis guidelines to allow for expeditious management and for standardization in reporting. (2) Methods: the Delphi method, an extensive literature review, iterative rounds of surveys, and expert panel discussions were used to establish definition, treatment, and prophylaxis guidelines for cholangitis in the first year after HPE. (3) Results: Eight elements (pooled into two groups: clinical and laboratory/imaging) were identified to define cholangitis after HPE. The final proposed definitions for suspected and confirmed cholangitis are a combination of one element, respectively, two elements from each group; furthermore, the finding of a positive blood culture was added to the definition of confirmed cholangitis. The durations for prophylaxis and treatment of suspected and confirmed cholangitis were uniformly agreed upon by the experts. (4) Conclusions: for the first time, an international consensus was found for guidelines for definition, treatment, and prophylaxis for cholangitis during the first year after Kasai HPE. Applicability will need further prospective multicentered studies.

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Ten-Year Experience in the Prevention of Post-Kasai Cholangitis

Cited by 9 publications

References 22 publications

Intravenous antibiotics for the treatments of cholangitis after Kasai operation in biliary atresia patients

Intravenous antibiotics for the treatments of cholangitis after Kasai operation in biliary atresia patients

Severity assessment to guide empiric antibiotic therapy for cholangitis in children after Kasai portoenterostomy: a multicenter prospective randomized control trial in China

Cholangitis Definition and Treatment after Kasai Hepatoportoenterostomy for Biliary Atresia: A Delphi Process and International Expert Panel

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