Efficacy and safety of post-Kasai steroid-based protocol in biliary atresia.

OBJECTIVES

This study aims to assess whether steroid-based regimen enhances the clearance of jaundice and improves native liver survival (NLS).

METHODS

We included all infants with biliary atresia (BA) undergoing Kasai portoenterostomy (KPE) at our centre. The algorithm-initiated prednisolone was initiated if stools remained acholic.

RESULTS

Of 127 infants, 70 formed the steroid group (SG) and 57 the historical cohort (HC). Jaundice clearance at 6 months was superior with steroids (61.4% vs. 38.6%; odds ratio [OR] 2.53, 95% confidence interval [CI] 1.23-5.19, p = 0.013). Kaplan-Meier analysis demonstrated improved 24-month NLS (log-rank p = 0.044) in SG. Multivariate analysis identified younger age at KPE (adjusted odds ratio [aOR] 1.021 per day, 95% CI 1.004-1.038, p = 0.016), lower pre-operative bilirubin (aOR 1.163, 95% CI 1.024-1.320, p = 0.020) and steroid use (aOR 2.13, 95% CI 1.001-4.53, p = 0.050) as independent predictors of success.

CONCLUSIONS

Moderate-dose prednisolone after KPE enhances early bile drainage and prolongs native liver survival. Optimal benefit is achieved when surgery is performed at ≤70 days of age.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06447051 (Clinicaltrials.gov) https://clinicaltrials.gov/study/NCT06447051.