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Intravenous immunoglobulin for the treatment of intractable cholangitis after Kasai portoenterostomy in biliary atresia patients

Pediatric Surgery International volume 34, pages 399–404 (2018)Cite this article

Abstract

Objective

To assess the efficacy of intravenous immunoglobulin (IVIG) as add-on treatment for intractable cholangitis (IC) after Kasai portoenterostomy (KPE) in biliary atresia (BA) patients.

Methods

113 BA patients who had one or more episodes of cholangitis after KPE were recruited in this study. According to whether response to routine conservative treatment, all patients were divided into IC group and simple cholangitis (SC) group. Meanwhile, patients with IC subdivided into IVIG group and control group according to whether application of IVIG.

Results

The IC group had higher serum procalcitonin (PCT) (P = 0.014), C-reactive protein (CRP) (P = 0.023), and γ-Gltamyltranspeptidase (γ-GGT) (P = 0.031) level than the SC group. The IVIG group had shorter duration of fever after treatment (P = 0.011) and length of hospital stay (P = 0.018) than the control group. The time until recurrent episode of cholangitis was significant longer in IVIG group than in control group (P = 0.019).

Conclusions

IVIG as add-on treatment may be an effective treatment for the cholangitis acute episode, and we conclude by calling for more prospective studies to attest to the role of IVIG in the treatment of cholangitis.

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Fig. 1

Abbreviations

BA:

Biliary atresia

KPE:

Kasai portoenterostomy

IVIG:

Intravenous immunoglobulin

IC:

Intractable cholangitis

ALT:

Alanine transaminase

AST:

Aspartate transaminase

SC:

Simple cholangitis

PCT:

Procalcitonin

CRP:

C-reactive protein

γ-GGT:

γ-Gltamyltranspeptidase

WBC:

White blood cell count

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Funding

This study was supported by grants from the National Natural Science Foundation of China (no. 81571478).

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Affiliations

  1. Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China

    Dandan Li, Pei Wang, Ying He, Chunlei Jiao, Didi Zhuansun, Nannan Wei, Jixin Yang & Jiexiong Feng

Authors
  1. Dandan Li
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  2. Pei Wang
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  3. Ying He
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  4. Chunlei Jiao
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  5. Didi Zhuansun
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  6. Nannan Wei
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  7. Jixin Yang
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  8. Jiexiong Feng
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Corresponding author

Correspondence to Jiexiong Feng.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Institutional Review Board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology approved the protocol of the study (Permit Number 2010-HP0761, Wuhan, China). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from the guardians of the patients included in this study.

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Li, D., Wang, P., He, Y. et al. Intravenous immunoglobulin for the treatment of intractable cholangitis after Kasai portoenterostomy in biliary atresia patients. Pediatr Surg Int 34, 399–404 (2018). https://doi.org/10.1007/s00383-018-4240-6

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  • DOI: https://doi.org/10.1007/s00383-018-4240-6

Keywords

  • Biliary atresia
  • Kasai portoenterostomy
  • Intravenous immunoglobulin
  • Cholangitis
  • Intractable cholangitis