Review ArticlePostoperative steroid therapy for biliary atresia: Systematic review and meta-analysis☆,☆☆,★,★★,☆☆☆
Section snippets
Study selection
Articles from January 1968 to August 2014 in the MEDLINE, EMBASE, Google scholar and Cochrane databases were searched systematically using different combinations of the following terms: “biliary atresia”, “hepatoportoenterostomy”, “KASAI procedure”, “steroid”, “corticosteroid”, “dexamethasone”, “prednisolone” and “hydrocortisone”. The “related articles” function was used to widen the search. The reference lists of the full articles were also manually searched to identify additional eligible
Study characteristics
Twelve studies met the inclusion criteria. Five studies were removed based on our exclusion criteria, leaving 2 RCT and 5 OCS for meta-analysis [3], [9], [10], [11], [12], [13], [14] (Fig. 1; Table 1).
Our study included 487 patients: 259 cases received standard nonsteroid treatment and 228 cases received steroid therapies after KASAI procedure. The steroid therapy regimens varied among studies (Table 1). One RCT study (Davenport 2007) [9] used low doses of steroids (prednisolone 2 mg/kg/day) in
Discussion
Our study shows that overall steroid therapy fails to improve jaundice clearance. However, a moderately high dose regimen of prednisolone 4–5 mg/kg/day for 1–2 weeks followed by at least 4 weeks of tapering dosage is associated with improved jaundice clearance, especially for infants who undergo hepatoportoenterostomy by 70 days of age.
Two previous meta-analyses have been reported addressing the issue of the effect of steroids on the outcome of biliary atresia, which showed no difference between
References (15)
- et al.
Postoperative steroids after Kasai portoenterostomy for biliary atresia: a systematic review
Int J Surg
(2014) - et al.
Effect of corticosteroid therapy on outcomes in biliary atresia after Kasai portoenterostomy
J Pediatr Surg
(2006) - et al.
Optimum prednisolone usage in patients with biliary atresia postportoenterostomy
J Pediatr Surg
(2005) - et al.
Postoperative corticosteroid therapy for bile drainage in biliary atresia—a nationwide survey
J Pediatr Surg
(2004) - et al.
Kasai portoenterostomy: 12-year experience with a novel adjuvant therapy regimen
J Pediatr Surg
(2007) - et al.
Glucocorticoid receptor alpha expression in the intrahepatic biliary epithelium and adjuvant steroid therapy in infants with biliary atresia
J Pediatr Surg
(2005) - et al.
Steroids in biliary atresia: single surgeon, single centre, prospective study
J Hepatol
(2013)
Cited by (47)
Customized Postoperative Therapy Improves Bile Drainage in Biliary Atresia: A Single Center Preliminary Report
2023, Journal of Pediatric SurgeryCitation Excerpt :Despite this bias, our findings should not be interpreted as a justification for the indiscriminate use of corticosteroids in all patients who fail to normalize stool color after HPE. In fact, the use of corticosteroids as an adjuvant treatment following HPE remains controversial, with current systematic reviews and meta analyses agreeing on the need for more controlled studies [10,12,15,16]. The STeroids in biliary Atresia Randomized Trial (START), showed no significant differences in biliary drainage between the corticosteroid and the placebo group [7].
Long-term outcomes of biliary atresia patients surviving with their native livers
2022, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :Overall, most NL survivors appear to have a HRQoL comparable to healthy subjects. Adjuvant therapy with short courses of high-dose steroids during the immediate postoperative period have associated with improved COJ rates [79–84], a finding supported a meta-analysis [83]. However, randomized controlled trials (RCT) have not found the use of steroids to associate with improved COJ rates [85,86], and none of the randomized or prospective trials could demonstrate any benefit of steroids regarding NLS [82,85,86].
Short- and long-term outcomes after Kasai operation for type III biliary atresia: Twenty years of experience in a single tertiary Egyptian center-A retrospective cohort study
2021, Annals of Medicine and SurgeryCitation Excerpt :The Portal tracts ductal and/or ductular proliferation seen in BA occurs as a response to chronic cholestasis and/or comes from the ductular transformation of the periportal hepatocytes [74]. In our series; the mild form of portal tracts ductal and/or ductular proliferation was an independent predictor of jaundice resolution besides having a trend towards being an independent predictor of good NLS, similarly, Santos et al., 2009 [57] and Muthukanagarajan et al., 2016 [75] found better short-term NLS with a lesser degree of biliary proliferation. Advanced fibrosis was a significant predictor of jaundice persistence and independent predictor of poor NLS in our series, in similar, it was an independent predictor of poor long-term TFS in Hanalioğlu et al., 2019 [27] and Wildhaber et al., 2003 [70] studies.
Biliary atresia: East versus west
2020, Seminars in Pediatric SurgeryBiliary atresia: Potential for a new decade
2020, Seminars in Pediatric SurgeryRisk factors and prognostic effects of cholangitis after Kasai procedure in biliary atresia patients: A retrospective clinical study
2019, Journal of Pediatric Surgery
- ☆
Funding source: No funding was secured for this study.
- ☆☆
Financial disclosure: The authors have no financial relationships relevant to this article to disclose.
- ★
Conflict of interest: The authors have no conflict of interest to disclose.
- ★★
IRB approval: This study was deemed exempt by the institutional review board.
- ☆☆☆
Author's contribution: Dr Chen, Dr Nah, Dr Chiang and Dr Low contributed to the design, planning, and writing of the article. Dr Chen, Dr Nah and Dr Krishnaswamy extracted the data and performed the analysis. Dr Chen and Dr Nah drafted the initial manuscript which was jointly approved by all the authors. Dr Low is the guarantor of the work.