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Does the Treatment After Kasai Procedure Influence Biliary Atresia Outcome and Native Liver Survival?
Andrea Pietrobattista1, Antonella Mosca1, Daniela Liccardo1
1Department of Hepatology, Gastroenterology and Nutrition.
Insights
Adjuvant therapy (AT) after Kasai portoenterostomy (KP) for biliary atresia (BA) did not significantly improve outcomes like bilirubin levels or prevent cholangitis. Further research is needed to determine AT
Area of Science:
- Pediatric surgery
- Hepatology
- Gastroenterology
Background:
- Biliary atresia (BA) is a rare, progressive liver disease in infants leading to end-stage liver disease.
- Kasai portoenterostomy (KP) is the primary surgical treatment for BA.
- Adjuvant therapy (AT), including antibiotics and steroids, is sometimes used post-KP to prevent complications, but its efficacy is uncertain.
Purpose of the Study:
- To investigate the impact of adjuvant therapy (AT) on the outcomes of infants undergoing Kasai portoenterostomy (KP) for biliary atresia (BA).
- To evaluate whether AT reduces complications such as cholangitis and the need for liver transplantation (LT).
Main Methods:
- A retrospective study comparing 43 infants undergoing KP.
- 25 infants received AT (AT group) and 18 did not (AT-free group).
- Outcomes including bilirubin levels, liver disease scores, cholangitis incidence, and LT rates were compared at 1, 3, and 6 months post-KP.
Main Results:
- No significant differences were observed in anthropometric or laboratory parameters between the AT and AT-free groups.
- Incidences of clinical liver disease complications and cholangitis (33% vs. 28%) were similar between groups.
- Rates of survival to LT listing and survival without LT were not significantly different between the groups.
Conclusions:
- Adjuvant therapy (AT) following Kasai portoenterostomy (KP) for biliary atresia (BA) did not demonstrate significant benefits in this study.
- Conflicting results necessitate multicentered, prospective, randomized controlled trials to clarify the utility of AT, especially considering antimicrobial resistance.
Objectives:
Biliary atresia (BA) is a rare and progressive idiopathic disease affecting the biliary tract that can lead to end-stage liver disease. The main treatment is Kasai portoenterostomy (KP). The use of adjuvant therapy (AT; prophylactic antibiotics and steroids) after KP aims to prevent cholangitis and reduce the need for liver transplantation (LT), but there is a lack of evidence on their effectiveness. We investigated the impact of significant changes in the post-KP protocol on the overall outcomes of BA.
Methods:
We enrolled 43 consecutive infants undergoing KP at Bambino Gesù Children's Hospital between July 2012 and October 2018. We compared AT (AT group; n=25) against no treatment (AT-free group; n = 18).
Results:
No significant differences in anthropometric and laboratory parameters were shown between the 2 groups at baseline and every study evaluation (1, 3, and 6 months). The incidences of clinical complications of liver disease were similar. Six months post-KP, the achievement of serum total bilirubin ≤1.5 mg/dL and satisfactory Pediatric End-Stage Liver Disease scores were not significantly different between the 2 groups. Cholangitis was observed in 30% of patients in the first 6 months postoperatively: 33% and 28% in the AT-free and AT groups, respectively (P = 0.18). Survival to LT listing at 12 months and without LT at 24 months were not significantly different between the 2 groups (P > 0.05).
Conclusions:
AT after KP confirmed conflicting results; therefore, multicentered, prospective, randomized control studies are needed to better understand its utility after KP, especially in the multidrug resistance spread era.
