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Objective <p>Adjuvant steroids in the treatment of BA remains controversial. We sought to characterize variations in steroid use and their effect on postoperative outcomes in a multi-institutional cohort of BA patients.</p> Study design <p>PHIS was queried for all patients between 2017 and 2024 who were diagnosed with BA and underwent KPE. Patients who received ≥ 3 contiguous days of steroids within 7&#xa0;days of KPE were considered to have received postoperative steroids. The primary outcome was native liver survival, calculated using Kaplan–Meier analysis.</p> Results <p>504 patients from 37 hospitals with a median age of 52&#xa0;days (IQR: 35–69&#xa0;days) met inclusion criteria. 139 patients (28.6%) received adjuvant steroids. The steroid-treated cohort had a significantly longer postoperative LOS (P &lt; 0.001) and high-volume-KPE hospitals were significantly more likely to use adjuvant steroids (P &lt; 0.001). The majority of patients were started on steroids on POD#0. 5 hospitals utilized steroids in &gt; 50% of their patients after KPE. Kaplan–Meier analysis showed no difference in two-year native liver survival.</p> Conclusion <p>In this large multi-institutional cohort study, steroids were used early, with significant intra-hospital variation, and were associated with increased postoperative LOS and higher KPE volume. Larger multi-institutional studies with standardized steroid dosage regimens and extended long-term follow up are needed.</p> Level of evidence <p>III.</p>

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A national database study of adjuvant steroids following Kasai portoenterostomy for biliary atresia

  • 期刊论文

  • 发表日期：

    2026年3月22日

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  • Norah E. Liang,
  • Humza Thobani,
  • Anoosha Moturu,
  • Elijah Suh,
  • Saleem Islam,
  • Gillian L. Fell,
  • Jeong S. Hyun,
  • Karl G. Sylvester,
  • Stephanie D. Chao,
  • James C. Y. Dunn,
  • Faraz A. Khan

摘要

Objective

Adjuvant steroids in the treatment of BA remains controversial. We sought to characterize variations in steroid use and their effect on postoperative outcomes in a multi-institutional cohort of BA patients.

Study design

PHIS was queried for all patients between 2017 and 2024 who were diagnosed with BA and underwent KPE. Patients who received ≥ 3 contiguous days of steroids within 7 days of KPE were considered to have received postoperative steroids. The primary outcome was native liver survival, calculated using Kaplan–Meier analysis.

Results

504 patients from 37 hospitals with a median age of 52 days (IQR: 35–69 days) met inclusion criteria. 139 patients (28.6%) received adjuvant steroids. The steroid-treated cohort had a significantly longer postoperative LOS (P < 0.001) and high-volume-KPE hospitals were significantly more likely to use adjuvant steroids (P < 0.001). The majority of patients were started on steroids on POD#0. 5 hospitals utilized steroids in > 50% of their patients after KPE. Kaplan–Meier analysis showed no difference in two-year native liver survival.

Conclusion

In this large multi-institutional cohort study, steroids were used early, with significant intra-hospital variation, and were associated with increased postoperative LOS and higher KPE volume. Larger multi-institutional studies with standardized steroid dosage regimens and extended long-term follow up are needed.

Level of evidence

III.