A national database study of adjuvant steroids following Kasai portoenterostomy for biliary atresia

Authors

• Norah E Liang E. Liang, Stanford University School of Medicine,USA
• Humza Thobani, Stanford University School of Medicine,USA
• Anoosha Moturu, Stanford University School of Medicine,USA
• Elijah Suh, Stanford University School of Medicine,USA
• Gillian L. Fell, Stanford University School of Medicine,USA
• Jeong S. Hyun, Stanford University School of Medicine,USA
• Karl G. Sylvester, Stanford University School of Medicine,USA
• Stanford University School of Medicine,USA
• Saleem Islam, Aga Khan UniversityFollow
• Faraz A. Khan, Stanford University School of Medicine,USA

Document Type

Article

Department

Paediatric Surgery

Abstract

Objective: Adjuvant steroids in the treatment of BA remains controversial. We sought to characterize variations in steroid use and their effect on postoperative outcomes in a multi-institutional cohort of BA patients.
Study design: PHIS was queried for all patients between 2017 and 2024 who were diagnosed with BA and underwent KPE. Patients who received ≥ 3 contiguous days of steroids within 7 days of KPE were considered to have received postoperative steroids. The primary outcome was native liver survival, calculated using Kaplan-Meier analysis.
Results: 504 patients from 37 hospitals with a median age of 52 days (IQR: 35-69 days) met inclusion criteria. 139 patients (28.6%) received adjuvant steroids. The steroid-treated cohort had a significantly longer postoperative LOS (P < 0.001) and high-volume-KPE hospitals were significantly more likely to use adjuvant steroids (P < 0.001). The majority of patients were started on steroids on POD#0. 5 hospitals utilized steroids in > 50% of their patients after KPE. Kaplan-Meier analysis showed no difference in two-year native liver survival.
Conclusion: In this large multi-institutional cohort study, steroids were used early, with significant intra-hospital variation, and were associated with increased postoperative LOS and higher KPE volume. Larger multi-institutional studies with standardized steroid dosage regimens and extended long-term follow up are needed.

Publication (Name of Journal)

Pediatric Surgery International

DOI

10.1007/s00383-026-06401

Recommended Citation

Liang, N. E., Thobani, H., Moturu, A., Suh, E., Fell, G. L., Hyun, J. S., Sylvester, K. G., , ., Islam, S., Khan, F. A. (2026). A national database study of adjuvant steroids following Kasai portoenterostomy for biliary atresia. Pediatric Surgery International, 42(1).
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_paediatr/213