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Analysis of Cholangitis Rates with Extended Perioperative Antibiotics and Adjuvant Corticosteroids in Biliary Atresia

Lynette Goh1, Kong Boo Phua1, Yee Low2

  • 1Gastroenterology, Hepatology & Nutrition Service, Pediatric Medicine, KK Women's and Children's Hospital, Singapore.

Pediatric Gastroenterology, Hepatology & Nutrition
|July 28, 2021
PubMed

Insights

Extended perioperative antibiotics and corticosteroids did not improve outcomes for biliary atresia patients after Kasai portoenterostomy. Further research is needed to optimize adjuvant therapies for biliary atresia (BA).

Area of Science:

  • Pediatric Surgery
  • Hepatology
  • Gastroenterology

Background:

  • Biliary atresia (BA) is a serious neonatal liver disease requiring surgical intervention.
  • Kasai portoenterostomy (KP) is the primary surgical procedure for BA.
  • Adjuvant therapies following KP lack established consensus, impacting patient outcomes.

Purpose of the Study:

  • To evaluate the impact of extended perioperative intravenous antibiotics (PI-Abx) and adjuvant corticosteroids on clinical outcomes in BA patients post-KP.
  • To analyze the rates of cholangitis, jaundice clearance, and native liver survival (NLS) within three years following KP.

Main Methods:

  • Retrospective analysis of 54 BA patients undergoing KP between 1999-2018.
  • Patients were divided into three groups based on PI-Abx duration and corticosteroid dosage: Group A (5-day PI-Abx), Group B (5-day PI-Abx + low-dose prednisolone), and Group C (14-day PI-Abx + high-dose prednisolone).

Main Results:

  • No significant difference in cholangitis episodes between groups (p=NS).
  • Jaundice clearance rates at 6 months and 3-year NLS rates showed no significant improvement with extended PI-Abx or corticosteroids (p=NS).
  • Persistence of jaundice at 6 months was significantly associated with adverse outcomes like decompensated cirrhosis or death at 3 years (p<0.001).

Conclusions:

  • Extended perioperative antibiotics and adjuvant corticosteroids do not appear to improve cholangitis rates, jaundice clearance, or native liver survival in biliary atresia patients post-Kasai portoenterostomy.
  • Jaundice persistence is a critical indicator for long-term prognosis in BA patients.
Abstract

Keywords:
AntibioticsBiliary atresiaCholangitisCirrhosisCorticosteroids

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