This article is more than 5 years old. Information may no longer be current.

Postoperative steroid therapy benefits infants with biliary atresia

Infants with biliary atresia who received prednisolone after Kasai portoenterostomy had improved liver biochemistry and were more likely to experience jaundice clearance than nonrecipients in a recent study.

Researchers evaluated 153 infants aged younger than 70 days with isolated biliary atresia (BA) who underwent Kasai portoenterostomy (KPE) between January 2000 and December 2011 at King’s College Hospital in London. Patients subsequently received either a low (n=18; total 37 mg/kg prednisolone) or high dose of steroids (n=44; total 75 mg/kg prednisolone), or no steroids (n=91).

Mark Davenport

“King’s College Hospital has had a major investment in BA for many years, and has possibly the largest series of infants and children in the world with this disease,” researcher Mark Davenport, ChM, FRCS, department of pediatric surgery at the hospital, told Healio.com. “BA is a rare and potentially life-threatening disease, and any kind of evidence that adjuvant therapy shows an improvement in outcome is worthwhile.”

Within 6 months, 57.5% of the cohort cleared jaundice, with steroid recipients experiencing clearance more frequently than nonrecipients (66% in the high-dose group and 67% in low-dose group vs. 52% of nonrecipients; P=.037). The high-dose group also experienced significant reductions to AST levels (155 IU/L to 118 IU/L; P=.0015), bilirubin (91 mcmol/L to 58 mcmol/L; P=.0015) and AST-to-platelet index (0.82 to 0.49; P=.005) compared with nonrecipients at 1 month post-KPE, and bilirubin levels remained lower in the high-dose group vs. nonrecipients at 6 months (P=.006).

Five of the eight deaths occurred after liver transplantation (LT), and patient survival at 4 years ranged from 94% in the low-dose group to 96% among nonrecipients. Native liver survival also was not significantly different at 4 years.

“There was definite evidence of a dose-related effect on early biochemical variables,” the researchers concluded. “This effect did translate to a significantly higher proportion of children who were jaundice-free … . [However,] we were not able to show statistically whether this had more long-term benefits in the form of a reduced need for LT. We will have to reserve judgment on its true effect in the longer term and await a future analysis.”