Customized postoperative therapy improves bile drainage in biliary atresia: A single center preliminary report

Sindhu Pandurangi, Seung Kim, Akihiro Asai, Alexander Bondoc, William Balistreri, Kathleen Campbell, Alexander Miethke, Anna Peters, Michael Rogers, Amy Taylor, Suzanna Labib Attia, Troy Gibbons, Bhargava Mullapudi, Rachel Sheridan, Greg Tiao, Jorge A. Bezerra

Research output: Contribution to journalArticlepeer-review


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. Level of evidence: III.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
StateAccepted/In press - 2022


  • Biliary atresia
  • Cholestasis
  • Hepatoportoenterostomy
  • Kasai

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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