Effect of Combined Ursodeoxycholic Acid and Glucocorticoid on the Outcome of Kasai Procedure: A Systematic Review and Meta-analysis

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2018 Sep 2

PMID 30170405

Citations 5

Authors

Jian-Li Qiu

Ming-Yi Shao

Wen-Fang Xie

Yue Li

Hai-Die Yang

Min-Min Niu

Hua Xu

Affiliations

Soon will be listed here.

Abstract

Introduction: Multiple studies have investigated the effect of ursodeoxycholic acid (UDCA) or glucocorticoid (GC) on the outcome of the hepatoportoenterostomy (Kasai procedure) in patients with biliary atresia (BA). However, the combined effect of these drugs (UDCA + GC) is little understood.

Methods: This meta-analysis specifically evaluated the effect of UDCA + GC after the Kasai procedure in patients with BA. A comprehensive literature search was conducted for all relevant articles in the electronic databases Medline, PubMed, Cochrane, Excerpta Medica Database (EMBASE), China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database on Disc (CBM-disc), and Vendor Information Pages (VIP).

Results: Eight studies with BA patients were finally included in our meta-analysis. The 8 identified studies consisted of 3 case-control, 3 cohort, and 2 randomized controlled trials (RCTs) with overall 530 subjects (144, 152, and 234 subjects, respectively). Among them, 312 patients were treated with UDCA + GC, while 218 received placebo or other intervention. The meta-analysis indicated that groups that received UDCA + GC had significantly lower rates of postoperative jaundice relative to the controls (pooled, odds ratio [OR] = 2.41; 95% confidence interval [CI] 1.44-4.04; Z = 3.34; P = .0008), while rates of cholangitis were similar (pooled, OR = 0.87; 95% CI 0.43-1.74; Z = 0.40; P = .69).

Conclusions: Combined UDCA and GC intervention was superior to that of the control in accelerating the clearance of serum bilirubin in patients with BA after the Kasai procedure. However, this conclusion requires further confirmation using RCTs of high methodological quality.

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References

Stringer M, Davison S, Rajwal S, McClean P . Kasai portoenterostomy: 12-year experience with a novel adjuvant therapy regimen. J Pediatr Surg. 2007; 42(8):1324-8. DOI: 10.1016/j.jpedsurg.2007.03.026. View

Willot S, Uhlen S, Michaud L, Briand G, Bonnevalle M, Sfeir R . Effect of ursodeoxycholic acid on liver function in children after successful surgery for biliary atresia. Pediatrics. 2008; 122(6):e1236-41. DOI: 10.1542/peds.2008-0986. View

Schreiber R, Barker C, Roberts E, Martin S, Alvarez F, Smith L . Biliary atresia: the Canadian experience. J Pediatr. 2007; 151(6):659-65, 665.e1. DOI: 10.1016/j.jpeds.2007.05.051. View

Chen Y, Nah S, Chiang L, Krishnaswamy G, Low Y . Postoperative steroid therapy for biliary atresia: Systematic review and meta-analysis. J Pediatr Surg. 2015; 50(9):1590-4. DOI: 10.1016/j.jpedsurg.2015.05.016. View

Feldman A, Mack C . Biliary atresia: cellular dynamics and immune dysregulation. Semin Pediatr Surg. 2012; 21(3):192-200. PMC: 3399127. DOI: 10.1053/j.sempedsurg.2012.05.003. View

Vejchapipat P, Passakonnirin R, Sookpotarom P, Chittmittrapap S, Poovorawan Y . High-dose steroids do not improve early outcome in biliary atresia. J Pediatr Surg. 2007; 42(12):2102-5. DOI: 10.1016/j.jpedsurg.2007.08.038. View

Sarkhy A, Schreiber R, Milner R, Barker C . Does adjuvant steroid therapy post-Kasai portoenterostomy improve outcome of biliary atresia? Systematic review and meta-analysis. Can J Gastroenterol. 2011; 25(8):440-4. PMC: 3186729. DOI: 10.1155/2011/125610. View

Meyers R, Book L, OGorman M, Jackson W, Black R, Johnson D . High-dose steroids, ursodeoxycholic acid, and chronic intravenous antibiotics improve bile flow after Kasai procedure in infants with biliary atresia. J Pediatr Surg. 2003; 38(3):406-11. DOI: 10.1053/jpsu.2003.50069. View

Escobar M, Jay C, Brooks R, West K, Rescorla F, Molleston J . Effect of corticosteroid therapy on outcomes in biliary atresia after Kasai portoenterostomy. J Pediatr Surg. 2006; 41(1):99-103. DOI: 10.1016/j.jpedsurg.2005.10.072. View

10.

Yamashiro Y, Ohtsuka Y, Shimizu T, NITTONO H, Urao M, Miyano T . Effects of ursodeoxycholic acid treatment on essential fatty acid deficiency in patients with biliary atresia. J Pediatr Surg. 1994; 29(3):425-8. DOI: 10.1016/0022-3468(94)90584-3. View

11.

Out C, Dikkers A, Laskewitz A, Boverhof R, van der Ley C, Kema I . Prednisolone increases enterohepatic cycling of bile acids by induction of Asbt and promotes reverse cholesterol transport. J Hepatol. 2014; 61(2):351-7. DOI: 10.1016/j.jhep.2014.03.025. View

12.

Tatekawa Y, Muraji T, Tsugawa C . Glucocorticoid receptor alpha expression in the intrahepatic biliary epithelium and adjuvant steroid therapy in infants with biliary atresia. J Pediatr Surg. 2005; 40(10):1574-80. DOI: 10.1016/j.jpedsurg.2005.06.017. View

13.

Carey E, Lindor K . Current pharmacotherapy for cholestatic liver disease. Expert Opin Pharmacother. 2012; 13(17):2473-84. DOI: 10.1517/14656566.2012.736491. View

14.

Sokol R, Shepherd R, Superina R, Bezerra J, Robuck P, Hoofnagle J . Screening and outcomes in biliary atresia: summary of a National Institutes of Health workshop. Hepatology. 2007; 46(2):566-81. PMC: 3888317. DOI: 10.1002/hep.21790. View

15.

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

16.

Petersen C, Harder D, Melter M, Becker T, Wasielewski R, Leonhardt J . Postoperative high-dose steroids do not improve mid-term survival with native liver in biliary atresia. Am J Gastroenterol. 2008; 103(3):712-9. DOI: 10.1111/j.1572-0241.2007.01721.x. View

17.

Zhang D, Yang H, Jia J, Zhao G, Yue M, Wang J . Postoperative steroids after Kasai portoenterostomy for biliary atresia: a meta-analysis. Int J Surg. 2014; 12(11):1203-9. DOI: 10.1016/j.ijsu.2014.08.407. View

18.

Hsiao C, Chang M, Chen H, Lee H, Wu T, Lin C . Universal screening for biliary atresia using an infant stool color card in Taiwan. Hepatology. 2008; 47(4):1233-40. DOI: 10.1002/hep.22182. View

19.

Davenport M, Parsons C, Tizzard S, Hadzic N . Steroids in biliary atresia: single surgeon, single centre, prospective study. J Hepatol. 2013; 59(5):1054-8. DOI: 10.1016/j.jhep.2013.06.012. View

20.

Kotb M . Ursodeoxycholic acid in neonatal hepatitis and infantile paucity of intrahepatic bile ducts: review of a historical cohort. Dig Dis Sci. 2008; 54(10):2231-41. DOI: 10.1007/s10620-008-0600-8. View