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Article: Evaluation of a standardized protocol in the use of steroids after Kasai operation

TitleEvaluation of a standardized protocol in the use of steroids after Kasai operation
Authors
KeywordsBiliary atresia
Kasai portoenterostomy
Liver transplantation
Steroids
Issue Date2008
PublisherSpringer Verlag. The Journal's web site is located at http://link.springer.de/link/service/journals/00383/index.htm
Citation
Pediatric Surgery International, 2008, v. 24 n. 9, p. 1001-1004 How to Cite?
AbstractAlthough the Kasai operation is still the treatment of choice for infants with biliary atresia, the long-term success rate, as defined by survival without transplantation, is only about 25-40%. It has been proposed that post-operative inflammatory changes affect the bile flow and eventually lead to cholangitis and liver failure. Recent case reports have suggested that the administration of steroids post-operatively can improve outcomes. Since 2004, our unit has adopted a strict protocol for the use of post-operative steroids for patients who undergo Kasai operation. The aim of this study is to access the early outcomes of these patients. A retrospective analysis was carried out for all patients who received Kasai operation between 1996 and 2006. For the treatment group, patients all received prednisolone at 4 mg/kg 1 week after operation as guided by protocol. The demographics and outcomes, including post operative bilirubin level, episodes of cholangitic attack, the need for early liver transplantation (transplant within 1 year of Kasai), and transplantation-free survival, were noted. Statistical analysis was done using Fisher's exact test and unpaired t-test when appropriate. A value of P < 0.05 was considered to be statistically significant. Kasai operation was performed in 30 patients (11 boys and 19 girls) during the study period. Thirteen patients received post-operative prednisolone according to protocol. The average age at operation and the mean preoperative bilirubin levels for the steroid and non-steroid group were not significantly different. A normal post-operative bilirubin (defined as bilirubin level less than 20 μmol/L) was achieved at 6 months in 7 (53.9%) patients who received steroid and 8 (47.0%) patients who did not (P = 0.71). A statistically significant reduction in the post-operative bilirubin level was also seen at 3 and 6 months in the steroid group. Early liver transplantation was required in 5 (38.5%) patients with steroid and 5 (29.4%) patients without it (P = 0.60). No significant difference in terms of cholangitic attack was observed. There was also no steroid-associated complication reported. We conclude that lower post-operative bilirubin level can be achieved with the routine use of prednisolone. However, there is no statistical improvement in terms of early liver transplantation and cholangitis. This may be attributed to the small sample size of our study population. Based on this pilot study, a multi-centre randomized trial is needed. © 2008 Springer-Verlag.
Persistent Identifierhttp://hdl.handle.net/10722/59966
ISSN
2015 Impact Factor: 1.01
2015 SCImago Journal Rankings: 0.409
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChung, HYen_HK
dc.contributor.authorWong, KKYen_HK
dc.contributor.authorLan, CLCen_HK
dc.contributor.authorTam, PKHen_HK
dc.date.accessioned2010-05-31T04:01:03Z-
dc.date.available2010-05-31T04:01:03Z-
dc.date.issued2008en_HK
dc.identifier.citationPediatric Surgery International, 2008, v. 24 n. 9, p. 1001-1004en_HK
dc.identifier.issn0179-0358en_HK
dc.identifier.urihttp://hdl.handle.net/10722/59966-
dc.description.abstractAlthough the Kasai operation is still the treatment of choice for infants with biliary atresia, the long-term success rate, as defined by survival without transplantation, is only about 25-40%. It has been proposed that post-operative inflammatory changes affect the bile flow and eventually lead to cholangitis and liver failure. Recent case reports have suggested that the administration of steroids post-operatively can improve outcomes. Since 2004, our unit has adopted a strict protocol for the use of post-operative steroids for patients who undergo Kasai operation. The aim of this study is to access the early outcomes of these patients. A retrospective analysis was carried out for all patients who received Kasai operation between 1996 and 2006. For the treatment group, patients all received prednisolone at 4 mg/kg 1 week after operation as guided by protocol. The demographics and outcomes, including post operative bilirubin level, episodes of cholangitic attack, the need for early liver transplantation (transplant within 1 year of Kasai), and transplantation-free survival, were noted. Statistical analysis was done using Fisher's exact test and unpaired t-test when appropriate. A value of P < 0.05 was considered to be statistically significant. Kasai operation was performed in 30 patients (11 boys and 19 girls) during the study period. Thirteen patients received post-operative prednisolone according to protocol. The average age at operation and the mean preoperative bilirubin levels for the steroid and non-steroid group were not significantly different. A normal post-operative bilirubin (defined as bilirubin level less than 20 μmol/L) was achieved at 6 months in 7 (53.9%) patients who received steroid and 8 (47.0%) patients who did not (P = 0.71). A statistically significant reduction in the post-operative bilirubin level was also seen at 3 and 6 months in the steroid group. Early liver transplantation was required in 5 (38.5%) patients with steroid and 5 (29.4%) patients without it (P = 0.60). No significant difference in terms of cholangitic attack was observed. There was also no steroid-associated complication reported. We conclude that lower post-operative bilirubin level can be achieved with the routine use of prednisolone. However, there is no statistical improvement in terms of early liver transplantation and cholangitis. This may be attributed to the small sample size of our study population. Based on this pilot study, a multi-centre randomized trial is needed. © 2008 Springer-Verlag.en_HK
dc.languageengen_HK
dc.publisherSpringer Verlag. The Journal's web site is located at http://link.springer.de/link/service/journals/00383/index.htmen_HK
dc.relation.ispartofPediatric Surgery Internationalen_HK
dc.subjectBiliary atresiaen_HK
dc.subjectKasai portoenterostomyen_HK
dc.subjectLiver transplantationen_HK
dc.subjectSteroidsen_HK
dc.titleEvaluation of a standardized protocol in the use of steroids after Kasai operationen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0179-0358&volume=24&spage=1001&epage=1004&date=2008&atitle=Evaluation+of+a+standardized+protocol+in+the+use+of+steroids+after+Kasai+operationen_HK
dc.identifier.emailKak Yuen Wong, K: kkywong@hkucc.hku.hken_HK
dc.identifier.emailKwong Hang Tam, P: paultam@hkucc.hku.hken_HK
dc.identifier.authorityKak Yuen Wong, K=rp01392en_HK
dc.identifier.authorityKwong Hang Tam, P=rp00060en_HK
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1007/s00383-008-2200-2en_HK
dc.identifier.pmid18679691en_HK
dc.identifier.scopuseid_2-s2.0-50849107342en_HK
dc.identifier.hkuros149896en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-50849107342&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume24en_HK
dc.identifier.issue9en_HK
dc.identifier.spage1001en_HK
dc.identifier.epage1004en_HK
dc.identifier.isiWOS:000258675900005-
dc.publisher.placeGermanyen_HK
dc.identifier.scopusauthoridChung, HY=7404007447en_HK
dc.identifier.scopusauthoridKak Yuen Wong, K=24438686400en_HK
dc.identifier.scopusauthoridCheun Leung Lan, L=24484786900en_HK
dc.identifier.scopusauthoridKwong Hang Tam, P=7202539421en_HK
dc.identifier.citeulike3410208-

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