Customized Postoperative Therapy Improves Bile Drainage in Biliary Atresia: A Single Center Preliminary Report

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.

Automated summary

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.