Journal
JOURNAL OF PEDIATRIC SURGERY
Volume 58, Issue 8, Pages 1483-1488Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.jpedsurg.2022.10.050
Keywords
Biliary atresia; Hepatoportoenterostomy; Kasai; Cholestasis
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This study aimed to evaluate the efficacy of personalized use of antibiotics and corticosteroids in patients with biliary atresia after surgery. The results showed that the personalized medication group had a significantly higher success rate of bile drainage compared to the conventional treatment group, and also maintained more native livers at 2 years. Therefore, personalized medication may help improve postoperative bile drainage.
Background: Controversies in management of biliary atresia (BA) after hepatoportoenterostomy (HPE) lead to variable treatment protocols. We implemented standardized medical management after HPE, cus-tomizing the use of antibiotics and corticosteroids based on patient-specific factors. Methods: In this retrospective analysis, 20 consecutive infants underwent HPE for BA and were compared to a historical cohort. Analysis of successful biliary drainage 3 months after HPE (defined as serum total bilirubin < 2 mg/dL) was the primary endpoint; survival with native liver at 2 years was the secondary endpoint. Results: Sixteen of 20 (80%) infants had successful bile drainage, compared to 8 of 20 (40%) infants in the historical cohort ( P = 0.0225). Sixteen of 20 patients in the new protocol have reached 2 years of age or required liver transplantation. Among the sixteen, 11 (68.8%) are alive with native livers versus 10 of 20 (50%) in the historical cohort ( P = 0.0970). Conclusion: This preliminary report suggests the potential benefit of tailored use of postoperative antibi-otics and corticosteroids in improving biliary drainage after HPE. Level of evidence: III. & COPY; 2022 Published by Elsevier Inc.
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