Postoperative steroid therapy for biliary atresia: Systematic review and meta-analysis ★★★

Background/ObjectivesAdjuvant steroid therapy has become popular in the postoperative management of biliary atresia. However, the benefits of steroid therapy are still not clear. We performed a systematic review and meta-analysis to determine the effect of steroids on bile drainage posthepatoportoenterostomy.MethodsStudies published from 1968 to 2014 were searched from MEDLINE, EMBASE, Google scholar and Cochrane databases. A meta-analysis of randomized controlled trials (RCT) and observational studies comparing bile drainage between steroid and nonsteroid therapies posthepatoportoenterostomy was performed.ResultsSeven studies (2 RCTs and 5 observational studies) were included, comprising 259 cases of nonsteroid and 228 cases of steroid therapies. There was no statistical improvement in jaundice clearance in the steroid group [pooled odds ratio (OR) = 1.51; 95% confidence interval (CI) 0.95–2.41; P = 0.08; I2 = 30%]. Among 7 studies, 4 studies applied similar moderate high-dose steroid regimens (prednisolone 4–5 mg/kg/day for 1–2 weeks followed by weeks of tapering dosage). However, these moderate high-dose regimens demonstrated improved jaundice clearance at 6 months posthepatoportoenterostomy (pooled OR = 1.59; 95% CI 1.03–2.45; P = 0.04; I2 = 0%). A subgroup analysis also showed that the effect of those moderate high-dose steroids was more pronounced in infants operated on by 70 days of age (pooled OR = 1.86; 95% CI 1.08–3.22; P = 0.03; I2 = 0%).ConclusionModerate high-dose steroid therapy improves jaundice clearance, especially for infants who undergo hepatoportoenterostomy by 70 days of age. However, more RCTs with longer follow-up are necessary to demonstrate the effect of steroids on the long-term outcomes of biliary atresia.