Improving Outcome of Kasai Portoenterostomy with Use of Steroid and Antibiotics – Case Reports

Abstract

Purpose: Early reports suggest that the use of steroids and antibiotics after Kasai portoenterostomy may improve bile flow and outcomes in infants with biliary atresia. Under the guidance of these reports, we use intravenous antibiotics and high dose tapering steroids in our patients with biliary atresia. Methods: Six infants underwent Kasai portoenterostomy between 2001 and 2005 in our institution. The age range at the time of surgery was 4 to 7 weeks. All patients received ursodeoxycolic acid indefinitely, tapering dose of steroids and intravenous antibiotics for 3 weeks. After 3 weeks the patients either received oral antibiotics or continue intravenous antibiotics depending on their direct bilirubin, GGT and platelet levels. Cholangitis is defined as elevated bilirubin level, GGT or platelet counts as a marker of acute phase reactant. The mean duration of steroid therapy was 15.6 weeks (range 7–35 weeks). The mean duration of intravenous antibiotics was 6.8 weeks (range 3–10 weeks). Most patients had elevated direct bilirubin level after Kasai procedure. Four patients at the end of antibiotic and steroid course had normal bilirubin levels and currently doing well after mean follow-up of 2.9 years ranging 1–5years. Two patients continued to have progressive disease and underwent liver transplantation. One of these two patients had congenital form of biliary atresia with situs inversus and polysplenia. Results: It is our observation that prolonged course of antibiotics and steroid use improves the outcome in 4 out of 6 patients. Congenital form is known to have poor outcome and the use of steroids and antibiotics did not make any change in the progression of disease. In our patients, we used wide range of antibiotics and steroids depending on the patients clinical and laboratory evaluation. Conclusions: More controlled studies are needed to decide the duration and the dosage of antibiotics and steroids and parameters to stop or continue these medications.