Postoperative corticosteroid therapy for bile drainage in biliary atresia - A nationwide survey

Purpose Members of the Japanese Biliary Atresia Society were surveyed to determine their current practice regarding early use of corticosteroids after Kasai's operation. Methods Questions included the patient's background data, dosage, timing, complications, and outcome. Anicteric survival with the native liver was statistically compared between groups categorized by steroid dosage using Kaplan-Meier analysis. Results Among 54 institutions surveyed, a total of 222 patients with uncorrectable BA were collected from 34 responders, including 208 patients who received steroid therapy and 14 without it. Prednisolone was started during the first postoperative week in 31% and during the second week in 64%. Perforation and peritonitis occurred in 1 patient given 3 mg/kg/d of prednisolone on postoperative day 1. The survival rates of the steroid and nonsteroid groups were 58.0% and 35.7%, respectively (P = .052). The initial dose of prednisolone was ≤3.9 mg/kg/d in 100 patients and ≥4.0 mg/kg/d in 108 patients. The survival rates of the group receiving ≥4.0 mg/kg/d and the nonsteroid group were 58.9% and 35.7%, respectively (P = .0494). Conclusions (1) Most surgeons use steroids. (2) Although the anicteric survival rate was higher in the steroid group, the number of patients in the nonsteroid group was too small to draw conclusions. (3) The recommended initial steroid dose is ≥4.0 mg/kg/d. (4) Complications are uncommon if administration is not started too early.