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

TY - JOUR

T1 - Steroids in biliary atresia

T2 - Single surgeon, single centre, prospective study

AU - Davenport, Mark

AU - Parsons, Chris

AU - Tizzard, Sarah

AU - Hadzic, Nedim

PY - 2013/11

Y1 - 2013/11

N2 - Background & Aims: The effect of adjuvant steroids in infants with biliary atresia (BA) is not clear and evidence of benefit is lacking. Methods: During the period Jan. 2000-Dec. 2011, 153 infants with isolated (CMV IgM - ve) BA underwent Kasai portoenterostomy (KPE) at <70 days. They were divided into three groups: LOW-dose steroid (from a previous randomized trial; starting prednisolone 2 mg/kg/day, n = 18), HIGH-dose steroid (starting prednisolone 5 mg/kg/day, n = 44), and NO steroid [n = 72 + 19 placebo (from randomized trial) = 91]. Outcome was assessed by early liver biochemistry, clearance of jaundice (<20 lmol/L), and actuarial native liver survival. Data are quoted as median (IQ range) and compared with non-parametric ANOVA, Chi or Logrank tests as appropriate. p Results: All three groups were comparable for age (ANOVA, p = 0.31) and a surrogate marker of liver fibrosis [aspartate-aminotransferase index (APRi), ANOVA, p = 0.67]. At 1 month post KPE, there was a significant reduction in bilirubin [58 (25-91) vs. 91 (52-145) mu mol/L, p = 0.0015], AST [118 (91-159) vs. 155 (108-193) IU/L, p = 0.0015], and APRi [0.49 (0.28-0.89) vs. 0.82 (0.45-1.2), p = 0.005] for HIGH vs. NO steroid. There was a significant increase in % clearance of jaundice with the use of steroids [47/91 (52%) vs. 12/18 (67%) vs. 29/44 (66%); steroids vs. no steroids, p = 0.037]. There was no statistical difference in 4-year patient survival (96% vs. 94% vs. 95%) or native liver survival (4 year = 46% vs. 50 vs. 57%). Conclusions: The adjuvant use of prednisolone significantly improved early post-operative liver biochemistry (especially at the higher dose), and increased the proportion of infants who cleared their jaundice at 6 months post-KPE.

AB - Background & Aims: The effect of adjuvant steroids in infants with biliary atresia (BA) is not clear and evidence of benefit is lacking. Methods: During the period Jan. 2000-Dec. 2011, 153 infants with isolated (CMV IgM - ve) BA underwent Kasai portoenterostomy (KPE) at <70 days. They were divided into three groups: LOW-dose steroid (from a previous randomized trial; starting prednisolone 2 mg/kg/day, n = 18), HIGH-dose steroid (starting prednisolone 5 mg/kg/day, n = 44), and NO steroid [n = 72 + 19 placebo (from randomized trial) = 91]. Outcome was assessed by early liver biochemistry, clearance of jaundice (<20 lmol/L), and actuarial native liver survival. Data are quoted as median (IQ range) and compared with non-parametric ANOVA, Chi or Logrank tests as appropriate. p Results: All three groups were comparable for age (ANOVA, p = 0.31) and a surrogate marker of liver fibrosis [aspartate-aminotransferase index (APRi), ANOVA, p = 0.67]. At 1 month post KPE, there was a significant reduction in bilirubin [58 (25-91) vs. 91 (52-145) mu mol/L, p = 0.0015], AST [118 (91-159) vs. 155 (108-193) IU/L, p = 0.0015], and APRi [0.49 (0.28-0.89) vs. 0.82 (0.45-1.2), p = 0.005] for HIGH vs. NO steroid. There was a significant increase in % clearance of jaundice with the use of steroids [47/91 (52%) vs. 12/18 (67%) vs. 29/44 (66%); steroids vs. no steroids, p = 0.037]. There was no statistical difference in 4-year patient survival (96% vs. 94% vs. 95%) or native liver survival (4 year = 46% vs. 50 vs. 57%). Conclusions: The adjuvant use of prednisolone significantly improved early post-operative liver biochemistry (especially at the higher dose), and increased the proportion of infants who cleared their jaundice at 6 months post-KPE.

KW - Biliary atresia

KW - Steroids, Prognosis

KW - Kasai portoenterostomy

KW - HIGH-DOSE STEROIDS

KW - PLATELET RATIO INDEX

KW - KASAI PORTOENTEROSTOMY

KW - CORTICOSTEROID-THERAPY

KW - ADJUVANT THERAPY

KW - IMPROVE

KW - INFANTS

KW - LIVER

U2 - 10.1016/j.jhep.2013.06.012

DO - 10.1016/j.jhep.2013.06.012

M3 - Article

SN - 0168-8278

VL - 59

SP - 1054

EP - 1058

JO - Journal of Hepatology

JF - Journal of Hepatology

IS - 5

ER -