Steroids in biliary atresia: single surgeon, single centre, prospective study

Area of Science:

• Pediatric Surgery
• Hepatology
• Neonatology

Background:

• Biliary atresia (BA) is a serious neonatal liver disease.
• The role of adjuvant steroids after Kasai portoenterostomy (KPE) for BA remains unclear.
• Evidence supporting steroid use in BA management is limited.

Purpose of the Study:

• To evaluate the efficacy of adjuvant steroid therapy in infants with biliary atresia undergoing KPE.
• To compare outcomes between low-dose steroid, high-dose steroid, and no steroid groups.
• To assess the impact of steroids on early liver biochemistry, jaundice clearance, and long-term survival.

Main Methods:

• A retrospective study of 153 infants with isolated BA undergoing KPE before 70 days of age.
• Infants were divided into LOW-dose steroid, HIGH-dose steroid, and NO steroid (including placebo) groups.
• Outcomes measured included early liver biochemistry, jaundice clearance (<20 μmol/L), and actuarial native liver survival.

Main Results:

• High-dose steroids significantly reduced bilirubin, AST, and aspartate-aminotransferase index (APRi) at 1 month post-KPE compared to no steroids.
• Steroid use significantly increased the percentage of infants clearing jaundice at 6 months (67% vs. 52%).
• No significant differences were observed in 4-year patient or native liver survival rates between groups.

Conclusions:

• Adjuvant prednisolone significantly improves early post-operative liver biochemistry in infants with BA.
• Higher doses of prednisolone showed a more pronounced effect on early liver function.
• Steroid therapy increases the proportion of infants achieving jaundice clearance post-KPE, but does not impact long-term survival.