Sarah Tizzard

King's College London, Londinium, England, United Kingdom

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Publications (13)43.39 Total impact

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    ABSTRACT: The effect of adjuvant steroids in infants with biliary atresia (BA) is not clear and evidence of benefit is lacking. During the period Jan. 2000 - Dec. 2011, 153 infants with isolated (CMV IgM-ve) BA underwent Kasai portoenterostomy (KPE) at < 70 days. They were divided into three groups: LOW-dose steroid (from a previous randomized trial; starting prednisolone 2mg/kg/day, n = 18), HIGH-dose steroid (starting prednisolone 5 mg/kg/day, n = 44) and NO steroid [n = 72 + 19 placebo (from randomized trial) = 91]. Outcome was assessed by early liver biochemistry, clearance of jaundice (<20 μmol/L) and actuarial native liver survival. Data are quoted as median (IQ range) and compared with non-parametric ANOVA, Chi or LogRank tests as appropriate. P ⩽0.05 was regarded as significant. All three groups were comparable for age (ANOVA, P = 0.31) and a surrogate marker of liver fibrosis [Aspartate-Aminotransferase index (APRi), ANOVA, P = 0.67]. At 1 month post KPE, there was a significant reduction in bilirubin [58(25-91) vs 91(52-145)μmol/L, P=0.0015], AST [118(91-159) vs. 155(108-193)IU/L, P=0.0015] and APRi [0.49(0.28-0.89) vs. 0.82 (0.45-1.2), P=0.005] for HIGH vs. NO steroid. There was a significant increase in% clearance of jaundice with the use of steroids [47/91(52%) vs. 12/18 (67%) vs. 29/44(66%); steroids vs. no steroids, P = 0.037]. There was no statistical difference in 4 year patient survival (96% vs. 94% vs. 95%) or native liver survival (4 year = 46% vs.50 vs.57%). The adjuvant use of prednisolone significantly improved early post-operative liver biochemistry (especially at the higher dose), and increased the proportion of infants who cleared their jaundice at six months post-KPE.
    Journal of Hepatology 06/2013; · 9.86 Impact Factor
  • Journal of Hepatology - J HEPATOL. 01/2010; 52.
  • Journal of Hepatology - J HEPATOL. 01/2010; 52.
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    ABSTRACT: The objective of this study was to evaluate adjuvant corticosteroids after Kasai portoenterostomy for biliary atresia. The study consisted of a prospective, 2-center, double-blind, randomized, placebo-controlled trial of post-Kasai portoenterostomy corticosteroids (oral prednisolone: 2 mg/kg/day from day 7 to day 21 and 1 mg/kg/day from day 22 to day 28). The data were compared with chi2 or Mann-Whitney tests, as appropriate. Seventy-one postoperative infants with type 3 biliary atresia were randomized to receive either oral prednisolone (n = 36) or a placebo (n = 37). At 1 month, the median bilirubin level was lower in the steroid group (66 versus 92 micromol/L, P = 0.06), but no difference was evident at 6 (P = 0.56) or 12 (P = 0.3) months. The proportion of infants with a normal bilirubin level (<20 micromol/L) at 6 (47% versus 49%, P = 0.89) and 12 months (50% versus 40%, P = 0.35) was not significantly different. The need for transplantation by 6 (12% versus 13%, P = 0.99) and 12 months (26% versus 35%, P = 0.47) was not significantly different. The steroid effect was more pronounced in younger infants (less than 70 days at Kasai portoenterostomy, n = 51), with a reduced bilirubin level at 1 month (64 versus 117 micromol/L, P = 0.01) and with a greater proportion with a normal bilirubin level at 12 months (54% versus 37%, P = 0.22). CONCLUSION: There was a beneficial effect on the rate of reduction of bilirubin in the early postoperative period (specifically in infants less than 70 days old at surgery), but this steroid regimen did not reduce the need for liver transplantation.
    Hepatology 12/2007; 46(6):1821-7. · 12.00 Impact Factor
  • Sarah Tizzard, Mark Davenport
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    ABSTRACT: This article aims to review the causes of jaundice, particularly conjugated jaundice in infants and the signs and symptoms of neonatal liver disease. The role of community practitioners in identifying prolonged jaundice in Infants will be discussed and a jaundice protocol and early identification algorithm will be introduced.
    Community practitioner: the journal of the Community Practitioners' & Health Visitors' Association 10/2007; 80(9):40-2.
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    ABSTRACT: Kasai portoenterostomy (KP) is regarded as first-line treatment for biliary atresia, although its postoperative course is often unpredictable. Hepatobiliary scintigraphy using technetium-labeled iminodiacetic acid derivatives offers a dynamic, objective assessment both of parenchymal liver function and restored biliary excretion. The value of postoperative radionuclide scans was assessed prospectively in a large population of post-KP infants. Radionuclide scans consisted of an intravenous dose of 20 MBq of 99mTc mebrofenin iminodiacetic acid and subsequent gamma camera imaging. Four scan variables were evaluated: the hepatic extraction fraction (HEF; ie, initial liver uptake divided by the peak vascular uptake), the half-life of tracer excretion (TEX), the shape of the excretion curve, and the presence of activity in the Roux loop at 4 hours postinjection. All infants had type 3 biliary atresia with a median age at KP of 59 days (24-120 days). To assess predictive value, outcome (clearance of jaundice and need for transplant) was assessed at 6 months (for 1-week scan) and 2 years (for 6-month scan). Eighty-seven infants underwent a radionuclide scan at 1 week post-KP. The median HEF was 34% (10%-90%). No relationship could be identified between HEF (P = .2) or excretion curve shape (P = .9) and outcome (at 6 months), and there were too few examples of a measurable TEX to allow meaningful comparison. The only predictive element at this time point was Roux loop activity (positive predictive value, 79%; negative predictive value, 53%; for "good" isotope bowel activity). Forty-four infants completed a second scan at 6 months. Median HEF increased from a baseline of 37% (11%-90%) to 64% (8%-100%) (P < .0001), although there was no significant intercorrelation (P = .12). The most predictive variables (of outcome at 2 years) were curve shape (positive predictive value, = 95%, negative predictive value, 82%) and TEX, and the least predictive was now Roux loop activity. Early (at 7 days) hepatic scintigraphy is not predictive of poor outcome in general, although Roux loop activity does indicate later success. Later hepatic scintigraphy (at 6 months) allows a detailed assessment of dynamic liver function with biliary excretion variables predictive of outcome in the medium term.
    Journal of Pediatric Surgery 06/2007; 42(6):1107-13. · 1.38 Impact Factor
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    ABSTRACT: We carried out a retrospective review of infants with biliary atresia splenic malformation (BASM). We found that 56 infants (10.2%) met the criteria for inclusion from a series of 548 infants (from January 1977 to December 2004). Syndromic infants were more likely to be female (P = .04) and to have a higher incidence of antenatal pathology (specifically maternal diabetes; 12.5% vs 1.2%; P < .0001). Situs inversus was noted in 21 (37%) and cardiac abnormalities in 25 (45%) infants. There were no differences in liver histology (eg, degree of liver fibrosis) or in the HLA genotype between BASM and nonsyndromic infants. Five-year and 10-year estimated native liver survival were 46% and 32%, respectively. There were 7 long-term survivors with their native liver and a follow-up of more than 10 years; all were anicteric. BASM is a distinct subgroup, with an implied onset during the embryological phase of organ development.
    Journal of Pediatrics 10/2006; 149(3):393-400. · 4.04 Impact Factor
  • Journal of Pediatric Gastroenterology and Nutrition - J PEDIAT GASTROENTEROL NUTR. 01/2005; 40(5):627-628.
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    ABSTRACT: Extrahepatic biliary atresia (EHBA) is the most common indication for liver transplantation in childhood. Most children who do not undergo transplant are reported to have chronic liver disease and its complications. The aim of this single-center study was to identify children with normal laboratory indices and no clinical evidence of chronic liver disease 10 or more years after Kasai portoenterostomy (KP). A retrospective analysis of the medical notes of all children surgically treated at the authors' center between 1979 and 1991 was undertaken. Criteria for inclusion were absence of surgical complications, unremarkable clinical examination, and normal bilirubin, aspartate aminotransferase, albumin, international normalized prothrombin ratio, and platelet count. Of 244 children surgically treated during the observation period, the authors identified 28 (11%) adolescents (14 male) who fulfilled the entry criteria. Their median age was 13.4 years (range, 10.2-22.2 years). Twenty-six with type 3 EHBA had conventional KP, whereas 2 underwent modified operations. The corrective surgery was performed at a median age of 58 days (range, 20-99 days). Median time of complete clearance of jaundice from the date of KP was 75 days (range, 21-339 days). Twelve (43%) patients had history of cholangitis at a median age of 3.4 years. The liver histologic findings were suggestive of mild to moderate fibrosis in 54.2% and cirrhosis in 40.7% of the patients who underwent biopsy. No child had gastrointestinal bleeding during follow-up. Thirteen (46%) patients had an elective esophagogastroduodenoscopy, which was normal in all. Twenty-six (93%) patients were in mainstream education, whereas the remaining two (7%) attended special school because of reasons unrelated to liver disease. A sizable proportion of children with EHBA avoid significant chronic liver disease and its complications 10 years or more after conventional surgical correction and have an excellent quality of life. Their good outcome is not hampered by isolated episodes of ascending cholangitis. Whether or not the residual histologic damage will become symptomatic during their lifetime remains to be established.
    Journal of Pediatric Gastroenterology and Nutrition 11/2003; 37(4):430-3. · 2.20 Impact Factor
  • European Journal of Pediatrics 08/2003; 162(7-8):539-40. · 1.91 Impact Factor
  • Hepatology 01/2003; 38:524-524. · 12.00 Impact Factor
  • Journal of Hepatology - J HEPATOL. 01/2002; 36:162-162.
  • Journal of Hepatology - J HEPATOL. 01/2002; 36:29-29.