Adjuvant steroid treatment following Kasai portoenterostomy and clinical outcomes of biliary atresia patients: an updated meta-analysis.
BACKGROUND
It is controversial whether adjuvant steroid treatment should be given to biliary atresia (BA) patients following a Kasai portoenterostomy (KPE). This study aimed to quantitatively and systematically evaluate the effect of adjuvant steroid therapy post-KPE in relation to major clinical outcomes of BA patients.


METHODS
We systematically reviewed the literature in PubMed, Embase, the Cochrane Library, China Knowledge Resource Integrated Database, Wanfang Database, Scholarly and Academic Information Navigator and manually searched for relevant papers published before August, 2015. We extracted data on the effects of steroid treatment following KPE on clinical outcome, including jaundice free rate and native liver survival rate at 6 months, 1 or 2 years after KPE. The weighted overall relative risk (RR) and 95% confidence intervals (CIs) were calculated by using a random-effects model.


RESULTS
Eight cohort studies and two randomized controlled trials (RCTs) were identified (n=998). Of them, 6 cohort studies and 2 trials investigated the effect of steroid treatment as compared to non-users or placebo (n=566), and 2 cohort studies compared the effects of high-dose to low-dose steroid treatment (n=432). Steroid usage increased the clearance rates of jaundice at 6 months (pooled RR: 1.32; 95% CI: 0.995-1.76; I2=72.6%) and 1 year (pooled RR: 1.35; 95% CI: 1.12-1.61; I2=0.0%), but not 2 years (pooled RR: 0.82; 95% CI: 0.55-1.22; I2=0.0%) after KPE. There was no solid evidence supporting that steroid treatment would improve native liver survival rate at 6 months (pooled RR: 1.02; 95% CI: 0.90-1.15; I2=0.0%), 1 year (pooled RR: 1.10; 95% CI: 0.91-1.34; I2=35.2%) or 2 years (pooled RR: 1.00; 95% CI: 0.73-1.35; I2=57.4%) after KPE.


CONCLUSIONS
Adjuvant steroid treatment following KPE may improve short-term (≤1 year) clearance rate of jaundice, but no significant effects on long-term (≥2 years) clearance rate of jaundice and native liver survival rate. Studies on doses and duration of steroids, and long-term follow-up studies are warranted.
Department of Pediatric Surgery, Xinhua hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, China.|Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, No. 1665, Kongjiang Road, Shanghai, China.
Min-Zhong
MZ
Zhang
Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, 1025 E. Seventh Street, Bloomington, IN, USA.
Peng-Cheng
PC
Xun
Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, 1025 E. Seventh Street, Bloomington, IN, USA.
Ka
K
He
Department of Pediatric Surgery, Xinhua hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, China. caiw1978@163.com.|Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, No. 1665, Kongjiang Road, Shanghai, China. caiw1978@163.com.|, No. 1665, Kongjiang Rd, Shanghai, 20092, China. caiw1978@163.com.
Wei
W
Cai
D001656:Biliary Atresia / Q000175:diagnosis / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002681:China; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007565:Jaundice / Q000517:prevention & control; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013256:Steroids / Q000627:therapeutic use*; D015996:Survival Rate; D016896:Treatment Outcome
D013256:Steroids
Kasai portoenterostomy; biliary atresia; steroid treatment