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KMID : 1038820210240040366
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Pediatric Gastroenterology, Hepatology & Nutrition
2021 Volume.24 No. 4 p.366 ~ p.376
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Analysis of Cholangitis Rates with Extended Perioperative Antibiotics and Adjuvant Corticosteroids in Biliary Atresia
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Goh Lynette
Phua Kong Boo
Low Yee
Chiang Li Wei
Yong Chen
Chiou Fang Kuan
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Abstract
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Purpose: There is no consensus regarding adjuvant therapies following Kasai portoenterostomy (KP) for biliary atresia (BA). This study aimed to analyze the effect of extended perioperative intravenous antibiotics (PI-Abx) and adjuvant corticosteroid on cholangitis and jaundice clearance rates in the 3 years post-KP in children with BA.
Methods: Data of patients who underwent KP between 1999-2018 at a single center were retrospectively analyzed. Group A (1999?2010) received PI-Abx for 5 days, Group B (2010?2012) received PI-Abx for 5 days plus low-dose prednisolone (2 mg/kg), and Group C (2012?2017) received PI-Abx for 14 days plus high-dose prednisolone (5 mg/kg).
Results: Fifty-four patients were included with groups A, B, and C comprising 25, 9, and 20 patients, respectively. The number of episodes of cholangitis was 1.0, 1.6, and 1.3 per patient (p=NS) within the first year and 1.8, 2.3, and 1.7 (p=NS) over 3 years in Groups A, B, and C, respectively. The jaundice clearance rate at 6 months was 52%, 78%, and 50% (p=NS), and the 3-year native liver survival (NLS) rate was 76%, 100%, and 80% (p=NS) in Groups A, B, and C, respectively. A near-significant association was observed between the incidence of cholangitis within the first year and decompensated liver cirrhosis/death at 3 years post KP (p=0.09). Persistence of jaundice at 6 months was significantly associated with decompensated cirrhosis/death at 3 years (p<0.001).
Conclusion: The extended duration of PI-Abx and adjuvant corticosteroids was not associated with improved rates of cholangitis, jaundice clearance, or NLS in patients with BA.
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KEYWORD
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Biliary atresia, Cholangitis, Cirrhosis, Antibiotics, Corticosteroids
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