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- Title
Adjuvant Therapy with Budesonide Post-Kasai Reduces the Need for Liver Transplantation in Biliary Atresia.
- Authors
Kuebler, Joachim F.; Madadi-Sanjani, Omid; Pfister, Eva D.; Baumann, Ulrich; Fortmann, David; Leonhardt, Johannes; Ure, Benno M.; Manns, Michael P.; Taubert, Richard; Petersen, Claus
- Abstract
Based on the hypothesis that autoimmunological factors coregulate the pathomechanism in biliary atresia (BA), adjuvant therapy with steroids has become routine, although its efficacy has never been proven. In 2010, a study on the advantages of budesonide compared to prednisolone in autoimmune hepatitis gave rise to experimental therapy using budesonide as an adjuvant BA treatment. Ninety-five BA patients prospectively received a budesonide 2 mg/dose rectal foam daily for three months (SG). A case-matched control group (CG: 81) was retrospectively recruited. The outcome measures were survival with native liver (SNL), determined at six months and two years after the Kasai procedure. The follow-up rate was 100%. At six months, SNL was statistically not different but became so after two years (SG: 54%; CG: 32%; p < 0.001). No steroid-related side effects were observed, except for eight patients with finally caught-up growth retardation. This study demonstrates for the first time a significantly longer survival with native liver in patients with BA after adjuvant therapy. However, indication, dosage, and duration of any budesonide application is not given in neonates with BA. Hence, we suggest extending the postoperative use of budesonide in a multicenter observational study with a clearly defined follow-up protocol, particularly in terms of potentially underestimated side effects.
- Subjects
BILIARY atresia; LIVER transplantation; BUDESONIDE; AUTOIMMUNE hepatitis; STEROID drugs; CHOLANGIOGRAPHY
- Publication
Journal of Clinical Medicine, 2021, Vol 10, Issue 24, p5758
- ISSN
2077-0383
- Publication type
Article
- DOI
10.3390/jcm10245758