A national database study of adjuvant steroids following Kasai portoenterostomy for biliary atresia
Norah E Liang1, Humza Thobani1, Anoosha Moturu1
1Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA.
Objective:
Adjuvant steroids in the treatment of BA remains controversial. We sought to characterize variations in steroid use and their effect on postoperative outcomes in a multi-institutional cohort of BA patients.
Study Design:
PHIS was queried for all patients between 2017 and 2024 who were diagnosed with BA and underwent KPE. Patients who received ≥ 3 contiguous days of steroids within 7 days of KPE were considered to have received postoperative steroids. The primary outcome was native liver survival, calculated using Kaplan-Meier analysis.
Results:
504 patients from 37 hospitals with a median age of 52 days (IQR: 35-69 days) met inclusion criteria. 139 patients (28.6%) received adjuvant steroids. The steroid-treated cohort had a significantly longer postoperative LOS (P < 0.001) and high-volume-KPE hospitals were significantly more likely to use adjuvant steroids (P < 0.001). The majority of patients were started on steroids on POD#0. 5 hospitals utilized steroids in > 50% of their patients after KPE. Kaplan-Meier analysis showed no difference in two-year native liver survival.
Conclusion:
In this large multi-institutional cohort study, steroids were used early, with significant intra-hospital variation, and were associated with increased postoperative LOS and higher KPE volume. Larger multi-institutional studies with standardized steroid dosage regimens and extended long-term follow up are needed.
Level Of Evidence:
III.
