title: Postoperative steroids after Kasai portoenterostomy for biliary atresia: a meta-analysis.
abstract: OBJECTIVE
  The aim of this systematic review and meta-analysis was to determine if adjunct steroids affect jaundice-free, cholangitis, and survival rates after Kasai portoenterostomy.
  
  
  METHODS
  The literature was searched using the following terms: biliary atresia, portoenterostomy, steroids, glucocorticoids, dexamethasone, prednisolone, and hydrocortisone. The primary outcome was the jaundice-free rate. Secondary outcomes were cholangitis and survival rates.
  
  
  RESULTS
  Ten studies were included in the systematic review and 8 in the meta-analyses. Steroid treatment regimens were inconsistent between studies. The pooled odds ratio (OR) for the jaundice-free rate did not significantly favor steroid over non-steroid treatment (1.95; 95% confidence interval [CI]: 0.91-4.11; P = 0.087), nor did the pooled OR for the cholangitis rate (0.75; 95% CI: 0.48-1.17; P = 0.202). Overall survival ranged from 58 to 95% in the steroid group and from 36 to 96% in the control group. Native liver survival ranged from 30 to 56% in the steroid group and from 31 to 48% in the control group. The survival data were not suitable for meta-analysis.
  
  
  CONCLUSIONS
  Although these results imply that adjunct steroids after Kasai portoenterostomy for BA may not improve jaundice-free or cholangitis rates, the quality of available evidence is limited and therefore not definitive. Additional high quality studies are needed.
authors.affiliation: Department of Pediatric Surgery, The First Affiliated Hospital of ZhengZhou University, 1st JianShe East Road, ZhengZhou 450052, China.
authors.forename: Da
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Pediatric Surgery, The First Affiliated Hospital of ZhengZhou University, 1st JianShe East Road, ZhengZhou 450052, China.
authors.forename: He-ying
authors.initials: HY
authors.lastname: Yang
authors.affiliation: Department of Pediatric Surgery, The First Affiliated Hospital of ZhengZhou University, 1st JianShe East Road, ZhengZhou 450052, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Jia
authors.affiliation: Department of Pediatric Surgery, The First Affiliated Hospital of ZhengZhou University, 1st JianShe East Road, ZhengZhou 450052, China.
authors.forename: Ge
authors.initials: G
authors.lastname: Zhao
authors.affiliation: Department of Pediatric Surgery, The First Affiliated Hospital of ZhengZhou University, 1st JianShe East Road, ZhengZhou 450052, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Yue
authors.affiliation: Department of Pediatric Surgery, The First Affiliated Hospital of ZhengZhou University, 1st JianShe East Road, ZhengZhou 450052, China. Electronic address: wjiaxiang@zzu.edu.cn.
authors.forename: Jia-xiang
authors.initials: JX
authors.lastname: Wang
mesh_terms: D001656:Biliary Atresia / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002761:Cholangitis / Q000453:epidemiology / Q000517:prevention & control*; D003907:Dexamethasone / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007565:Jaundice / Q000453:epidemiology / Q000517:prevention & control*; D011171:Portoenterostomy, Hepatic; D011182:Postoperative Care; D011239:Prednisolone / Q000627:therapeutic use; D015996:Survival Rate
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D011239:Prednisolone; D006854:Hydrocortisone
keywords: Cholangitis; Corticosteroid; Efficacy; Jaundice