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- Title
Does the Treatment After Kasai Procedure Influence Biliary Atresia Outcome and Native Liver Survival?
- Authors
Pietrobattista, Andrea; Mosca, Antonella; Liccardo, Daniela; Alterio, Tommaso; Grimaldi, Chiara; Basso, MariaSole; Saffioti, Maria Cristina; Della Corte, Claudia; Spada, Marco; Candusso, Manila; Corte, Claudia Della
- Abstract
<bold>Objectives: </bold>Biliary atresia (BA) is a rare and progressive idiopathic disease affecting the biliary tract that can lead to end-stage liver disease. The main treatment is Kasai portoenterostomy (KP). The use of adjuvant therapy (AT; prophylactic antibiotics and steroids) after KP aims to prevent cholangitis and reduce the need for liver transplantation (LT), but there is a lack of evidence on their effectiveness. We investigated the impact of significant changes in the post-KP protocol on the overall outcomes of BA.<bold>Methods: </bold>We enrolled 43 consecutive infants undergoing KP at Bambino Gesù Children's Hospital between July 2012 and October 2018. We compared AT (AT group; n=25) against no treatment (AT-free group; n = 18).<bold>Results: </bold>No significant differences in anthropometric and laboratory parameters were shown between the 2 groups at baseline and every study evaluation (1, 3, and 6 months). The incidences of clinical complications of liver disease were similar. Six months post-KP, the achievement of serum total bilirubin ≤1.5 mg/dL and satisfactory Pediatric End-Stage Liver Disease scores were not significantly different between the 2 groups. Cholangitis was observed in 30% of patients in the first 6 months postoperatively: 33% and 28% in the AT-free and AT groups, respectively (P = 0.18). Survival to LT listing at 12 months and without LT at 24 months were not significantly different between the 2 groups (P > 0.05).<bold>Conclusions: </bold>AT after KP confirmed conflicting results; therefore, multicentered, prospective, randomized control studies are needed to better understand its utility after KP, especially in the multidrug resistance spread era.
- Subjects
SURGICAL anastomosis; RETROSPECTIVE studies; SEVERITY of illness index; TREATMENT effectiveness; BILIARY atresia; LIVER failure; LONGITUDINAL method
- Publication
Journal of Pediatric Gastroenterology & Nutrition, 2020, Vol 71, Issue 4, p446
- ISSN
0277-2116
- Publication type
journal article
- DOI
10.1097/MPG.0000000000002837