Peri-operative high-dose V post-operative low dose steroid therapy in the management of biliary atresia: a preliminary report

ABSTRACT

The use of high-dose steroid therapy peri portoenterostomy may have a positive impact on the frequency of cholangitis and survival rate. A prospective study was conducted on two groups of patients [less than three months of age] suffering from biliary atresia from 1999 to 2005. The patients in group I [G I] were managed peri-operatively by high-dose methylprednisolone while the other group [G II] received low dose methylprednisolone only post-operatively [2mg/k/day for 1 month]. Infants in GI [n = 30] received methylprednisolone for 3 successive days before operation [10-8-6mg/kg/day], and 10 mg/k at the day of operation respectively. Thereafter the dose was tapered in the next successive 6 days by 8, 6, 5, 4, 3, and 2 mg/kg/day and continued for one month. Seventy two infants with biliary atresia were operated [39 girls and 33 boys]. Twenty-six of the 30 patients [86%] in G I became jaundice-free within 90 days after portoenterostomy while only seven [15%] of the 42 patients in G II had normal bilirubin [P < 0.0001]. Episodes of postoperative cholangitis in G I were 20% [6 of 30], and 53% [24 of 42] in G II [P < 0.005]. The difference in 3-year survival rate between the two groups is also remarkable Eighty seven percent [26 of 30] in GI versus 29% [13 of 45] in G II [P < 0.005]. Death related to biliary atresia occurred in 1 [3.3%] patient in GI compared with 12 [29%] patients in G II [p < 0.005]. These results provide strong evidence that peri-operative high dose steroid therapy is not only safe in this patients population, but because of its anti-inflammatory and cholerrhetic effects has a positive impact on preventing recurrent cholangitis, and ultimately survival