Adjuvant steroid treatment following Kasai portoenterostomy and clinical outcomes of biliary atresia patients: an update
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Adjuvant steroid treatment following Kasai portoenterostomy and clinical outcomes of biliary atresia patients: an updated meta-analysis Min-Zhong Zhang, Peng-Cheng Xun, Ka He, Wei Cai Shanghai, China 0.82; 95% CI: 0.55-1.22; I2=0.0%) after KPE. There was no solid evidence supporting that steroid treatment would improve native liver survival rate at 6 months (pooled RR: 1.02; 95% CI: 0.90-1.15; I2=0.0%), 1 year (pooled RR: 1.10; 95% CI: 0.91-1.34; I2=35.2%) or 2 years (pooled RR: 1.00; 95% CI: 0.73-1.35; I2=57.4%) after KPE.
Methods: We systematically reviewed the literature in PubMed, Embase, the Cochrane Library, China Knowledge Resource Integrated Database, Wanfang Database, Scholarly and Academic Information Navigator and manually searched for relevant papers published before August, 2015. We extracted data on the effects of steroid treatment following KPE on clinical outcome, including jaundice free rate and native liver survival rate at 6 months, 1 or 2 years after KPE. The weighted overall relative risk (RR) and 95% confidence intervals (CIs) were calculated by using a random-effects model.
Conclusions: Adjuvant steroid treatment following KPE may improve short-term (≤1 year) clearance rate of jaundice, but no significant effects on long-term (≥2 years) clearance rate of jaundice and native liver survival rate. Studies on doses and duration of steroids, and longterm follow-up studies are warranted.
Results: Eight cohort studies and two randomized controlled trials (RCTs) were identified (n=998). Of them, 6 cohort studies and 2 trials investigated the effect of steroid treatment as compared to non-users or placebo (n=566), and 2 cohort studies compared the effects of high-dose to lowdose steroid treatment (n=432). Steroid usage increased the clearance rates of jaundice at 6 months (pooled RR: 1.32; 95% CI: 0.995-1.76; I2=72.6%) and 1 year (pooled RR: 1.35; 95% CI: 1.12-1.61; I2=0.0%), but not 2 years (pooled RR:
Author Affiliations: Department of Pediatric Surgery, Xinhua hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, China (Zhang MZ, Cai W); Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, No. 1665, Kongjiang Road, Shanghai, China (Zhang MZ, Cai W); Department of Epidemiology and Biostatistics, School of Public Health--Bloomington, Indiana University, 1025 E. Seventh Street, Bloomington, IN, USA (Xun PC, He K) Corresponding Author: Wei Cai, No. 1665, Kongjiang Rd, Shanghai, 20092, China (Tel: +86-21-25076441; Fax: +86-21-65791316; Email: [email protected]) doi: 10.1007/s12519-016-0052-8
©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2016. All rights reserved. World J Pediatr, Online First, October 2016 . www.wjpch.com
World J Pediatr October 2016; Online First Key words: biliary atresia; Kasai portoenterostomy; steroid treatment
Introduction
B
iliary atresia (BA) is a disease with progressive obstruction of biliary tract during the neonatal period. It occurs in between 1 in 5
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