The objective of this study was to evaluate adjuvant
corticosteroids after Kasai portoenterostomy for
biliary atresia. The study consisted of a prospective, 2-center, double-blind, randomized, placebo-controlled trial of post-Kasai portoenterostomy
corticosteroids (oral
prednisolone: 2 mg/kg/day from day 7 to day 21 and 1 mg/kg/day from day 22 to day 28). The data were compared with chi2 or Mann-Whitney tests, as appropriate. Seventy-one postoperative infants with type 3
biliary atresia were randomized to receive either oral
prednisolone (n = 36) or a placebo (n = 37). At 1 month, the median
bilirubin level was lower in the
steroid group (66 versus 92 micromol/L, P = 0.06), but no difference was evident at 6 (P = 0.56) or 12 (P = 0.3) months. The proportion of infants with a normal
bilirubin level (<20 micromol/L) at 6 (47% versus 49%, P = 0.89) and 12 months (50% versus 40%, P = 0.35) was not significantly different. The need for
transplantation by 6 (12% versus 13%, P = 0.99) and 12 months (26% versus 35%, P = 0.47) was not significantly different. The
steroid effect was more pronounced in younger infants (less than 70 days at Kasai portoenterostomy, n = 51), with a reduced
bilirubin level at 1 month (64 versus 117 micromol/L, P = 0.01) and with a greater proportion with a normal
bilirubin level at 12 months (54% versus 37%, P = 0.22).
CONCLUSION: There was a beneficial effect on the rate of reduction of
bilirubin in the early postoperative period (specifically in infants less than 70 days old at surgery), but this
steroid regimen did not reduce the need for
liver transplantation.