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Customized Postoperative Therapy Improves Bile Drainage in Biliary Atresia: A Single Center Preliminary Report

  • Sindhu Pandurangi
    Affiliations
    Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Seung Kim
    Affiliations
    Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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  • Akihiro Asai
    Affiliations
    Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Alexander Bondoc
    Affiliations
    Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • William Balistreri
    Affiliations
    Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Kathleen Campbell
    Affiliations
    Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Alexander Miethke
    Affiliations
    Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Anna Peters
    Affiliations
    Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Michael Rogers
    Affiliations
    Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Amy Taylor
    Affiliations
    Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Suzanna Labib Attia
    Affiliations
    Division of Gastroenterology, Hepatology and Nutrition and Department of Pediatrics, University of Kentucky Children's Hospital, Lexington, Kentucky, USA
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  • Troy Gibbons
    Affiliations
    Division of Gastroenterology, Hepatology and Nutrition and Department of Pediatrics, University of Kentucky Children's Hospital, Lexington, Kentucky, USA
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  • Bhargava Mullapudi
    Affiliations
    Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Rachel Sheridan
    Affiliations
    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA

    Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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  • Greg Tiao
    Correspondence
    Co-Corresponding author: Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229
    Affiliations
    Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Jorge A. Bezerra
    Correspondence
    Co-Corresponding author: Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229
    Affiliations
    Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Published:November 04, 2022DOI:https://doi.org/10.1016/j.jpedsurg.2022.10.050

      ABSTRACT

      Background

      Controversies in management of biliary atresia (BA) after hepatoportoenterostomy (HPE) lead to variable treatment protocols. We implemented standardized medical management after HPE, customizing the use of antibiotics and corticosteroids based on patient-specific factors.

      Methods

      In this retrospective analysis, 20 consecutive infants underwent HPE for BA and were compared to a historical cohort. Analysis of successful biliary drainage 3 months after HPE (defined as serum total bilirubin <2 mg/dL) was the primary endpoint; survival with native liver at 2 years was the secondary endpoint.

      Results

      Sixteen of 20 (80%) infants had successful bile drainage, compared to 8 of 20 (40%) infants in the historical cohort (P=0.0225). Sixteen of 20 patients in the new protocol have reached 2 years of age or required liver transplantation. Among the sixteen, 11 (68.8%) are alive with native livers versus 10 of 20 (50%) in the historical cohort (P=0.0970).

      Conclusion

      This preliminary report suggests the potential benefit of tailored use of postoperative antibiotics and corticosteroids in improving biliary drainage after HPE.

      Keywords

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