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Biliary complications in pediatric liver transplantation: findings of percutaneous transhepatic cholangiography in a large single-center cohort

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Abstract

Background

Although biliary complications after orthotopic liver transplantation represent a common source of morbidity and mortality, decreasing graft survival, consensus is lacking on their management in the pediatric population.

Objective

The aim of this study was to present the prevalence of such biliary complications and their interventional radiologic management with representative images.

Materials and methods

This retrospective study reports our experience with percutaneous transhepatic cholangiography in the management of biliary complications after orthotopic liver transplantation in pediatric patients. This study enrolled all pediatric patients (<18 years old) who underwent percutaneous transhepatic cholangiography for the management of biliary complications after orthotopic liver transplantation at a tertiary care center between January 2010 and December 2020. Diagnosis of biliary complications and indication to perform percutaneous transhepatic cholangiography were based on clinical, laboratory or radiologic data.

Results

Among the 301 orthotopic liver transplantations, 78 (26%) developed biliary complications that were managed by interventional radiology: these included 52 (17.3%) biliary strictures, 19 (6.3%) bile leaks, 5 (1.7%) biliary stones, 1 (0.3%) iatrogenic biliary obstruction and 1 (0.3%) vanishing syndrome. The median time interval between orthotopic liver transplantation and the diagnosis of biliary complications was 6.0 years (interquartile range [IQR] 8.2 years). Percutaneous transhepatic cholangiography and biliary duct catheterization were successful in all cases, with low rates of complications that were variable among subgroups.

Conclusion

A wide spectrum of biliary complications can occur after pediatric orthotopic liver transplantation. In this large single-center experience, we highlight the value of percutaneous transhepatic cholangiography in their diagnosis and management. Percutaneous treatments in pediatric patients are safe and effective, providing resolution or serving as a bridge to surgery, including re-transplantation.

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Authors and Affiliations

  1. Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy

    Ludovico Dulcetta, Paolo Marra, Francesco Saverio Carbone, Pietro Andrea Bonaffini, Claudio Sallemi & Sandro Sironi

  2. School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

    Ludovico Dulcetta, Paolo Marra, Francesco Saverio Carbone, Pietro Andrea Bonaffini, Michele Colledan & Sandro Sironi

  3. Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy

    Naire Sansotta & Lorenzo D’Antiga

  4. Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy

    Michele Colledan

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  1. Ludovico Dulcetta
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  2. Paolo Marra
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  3. Francesco Saverio Carbone
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  4. Pietro Andrea Bonaffini
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  7. Michele Colledan
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  8. Lorenzo D’Antiga
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Correspondence to Paolo Marra.

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Dulcetta, L., Marra, P., Carbone, F.S. et al. Biliary complications in pediatric liver transplantation: findings of percutaneous transhepatic cholangiography in a large single-center cohort. Pediatr Radiol 52, 1061–1074 (2022). https://doi.org/10.1007/s00247-021-05278-3

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  • DOI: https://doi.org/10.1007/s00247-021-05278-3

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