Objective. The dosage, duration, and the benefits of high-dose
steroid treatment and outcome in
biliary atresia (BA) remain controversial. In this study, we evaluated the impact of high-dose
steroid therapy on the outcome of BA after the
Kasai procedure. Methods. Intravenous
prednisolone administration was started 1 week after surgery, followed by 8 to 12 weeks of oral
prednisolone. Total
bilirubin (TB) levels (3, 6, and 12 months after surgery), early onset of
cholangitis, and two-year native liver survival were evaluated. Results. 53.4%, 56.9%, and 58.1% of the patients in the high-dose
steroid group were
jaundice-free 3, 6, and 12 months after surgery, respectively; these values were significantly higher than the 38.7%, 39.4%, and 43.3% of the low-dose
steroid group. One year after surgery, the incidence of
cholangitis in the high-dose group (32.0%) was lower than that in the low-dose group (48.0%). Infants with native liver in the high-dose group had a better two-year survival compared to those in the low-dose
steroid group (53.7% versus 42.6%). Conclusions. The high-dose
steroid protocol can reduce the incidence of
cholangitis, increase the
jaundice-free rate, and improve two-year survival with native liver after the Kasai operation.