title: Postoperative steroid therapy for biliary atresia: Systematic review and meta-analysis.
abstract: OBJECTIVE
  Adjuvant steroid therapy has become popular in the postoperative management of biliary atresia. However, the benefits of steroid therapy are still not clear. We performed a systematic review and meta-analysis to determine the effect of steroids on bile drainage posthepatoportoenterostomy.
  
  
  METHODS
  Studies published from 1968 to 2014 were searched from MEDLINE, EMBASE, Google scholar and Cochrane databases. A meta-analysis of randomized controlled trials (RCT) and observational studies comparing bile drainage between steroid and nonsteroid therapies posthepatoportoenterostomy was performed.
  
  
  RESULTS
  Seven studies (2 RCTs and 5 observational studies) were included, comprising 259 cases of nonsteroid and 228 cases of steroid therapies. There was no statistical improvement in jaundice clearance in the steroid group [pooled odds ratio (OR)=1.51; 95% confidence interval (CI) 0.95-2.41; P=0.08; I(2)=30%]. Among 7 studies, 4 studies applied similar moderate high-dose steroid regimens (prednisolone 4-5mg/kg/day for 1-2 weeks followed by weeks of tapering dosage). However, these moderate high-dose regimens demonstrated improved jaundice clearance at 6 months posthepatoportoenterostomy (pooled OR=1.59; 95% CI 1.03-2.45; P=0.04; I(2)=0%). A subgroup analysis also showed that the effect of those moderate high-dose steroids was more pronounced in infants operated on by 70 days of age (pooled OR=1.86; 95% CI 1.08-3.22; P=0.03; I(2)=0%).
  
  
  CONCLUSIONS
  Moderate high-dose steroid therapy improves jaundice clearance, especially for infants who undergo hepatoportoenterostomy by 70 days of age. However, more RCTs with longer follow-up are necessary to demonstrate the effect of steroids on the long-term outcomes of biliary atresia.
authors.affiliation: Department of Pediatric Surgery. KK Women's & Children's Hospital, Singapore.
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Pediatric Surgery. KK Women's & Children's Hospital, Singapore.
authors.forename: Shireen Anne
authors.initials: SA
authors.lastname: Nah
authors.affiliation: Department of Pediatric Surgery. KK Women's & Children's Hospital, Singapore.
authors.forename: Liwei
authors.initials: L
authors.lastname: Chiang
authors.affiliation: Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Gita
authors.initials: G
authors.lastname: Krishnaswamy
authors.affiliation: Department of Pediatric Surgery. KK Women's & Children's Hospital, Singapore. Electronic address: low.yee@kkh.com.sg.
authors.forename: Yee
authors.initials: Y
authors.lastname: Low
mesh_terms: D001656:Biliary Atresia / Q000188:drug therapy* / Q000601:surgery; D004322:Drainage; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D011171:Portoenterostomy, Hepatic; D011182:Postoperative Care / Q000379:methods*; D011239:Prednisolone / Q000627:therapeutic use*
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone
keywords: Biliary atresia; Jaundice clearance; Kasai procedure; Pediatric; Steroid