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

Dulcetta, Ludovico; Marra, Paolo; Carbone, Francesco; Bonaffini, Pietro Andrea; Sallemi, Claudio; Sansotta, Naire; Colledan, M.; D’Antiga, Lorenzo; Sironi, Sandro

doi:10.1007/s00247-021-05278-3

Cited by 7 publications

(10 citation statements)

References 26 publications

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“…In adults, the incidence of biliary complications after liver transplantation has been reported in the range of 5%–25%; the prevalence of AS was reported in 4%–12% of patients, and NAS in 0.5%–20% 19,20 . In children, the incidence of biliary complications has been reported to reach 45%, and the overall incidence of BS has been reported in the range of 4%–12% 1,3,4 …”

Section: Discussionmentioning

confidence: 99%

“…Factors affecting anastomotic strictures (AS) include multiple bile duct anastomoses, small biliary duct caliber, and anastomosis type 6,7 . Non‐anastomotic strictures (NAS) occur both in the intrahepatic and extrahepatic biliary ducts of the liver graft, tend to occur in grafts from a deceased donor and mostly result from ischemia or immunologic causes (such as rejection and ABO incompatibility) 1,6,8 …”

Section: Introductionmentioning

confidence: 99%

“…Risk factors for the development of BS in pediatric patients are not well established 2,3,6,11–13 . While percutaneous biliary interventions are widely accepted procedures for treating BS in pediatric patients, data regarding their success rates and outcomes have accumulated only in recent years 1,2,5,14–16 . We therefore aimed to determine risk factors for the development of BS and to describe the treatment and outcomes of these patients.…”

Section: Introductionmentioning

confidence: 99%

“…Biliary complications are a significant cause of morbidity and graft loss following pediatric liver transplant (pLT) 1–3 . The incidence of biliary complications has been reported in the range of 8%–45% 1,2 . Complications mainly include biliary leak and biliary strictures (BS).…”

Section: Introductionmentioning

confidence: 99%

“…Clinical and laboratory findings are not specific for diagnosing BS, and imaging has a significant role in establishing the diagnosis 1 . Ultrasound (US) is the initial imaging tool; however, its sensitivity is limited and further evaluation by magnetic resonance cholangiography (MRCP) is often needed 2 .…”

Section: Introductionmentioning

confidence: 99%

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Biliary strictures post pediatric liver transplantation—incidence and risk factors in a single tertiary referral transplant center

Vingrovich,

Cooper,

Gurevich

et al. 2024

Pediatric Transplantation

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BackgroundBiliary strictures are a significant cause of morbidity and graft loss in pediatric liver transplant recipients. Risk factors for the development of biliary strictures are not fully established. We aimed to evaluate the incidence of biliary strictures and treatment modalities outcomes and to identify potential risk factors for occurrence.MethodsPediatric patients who underwent liver transplantation in the single tertiary pediatric liver transplant center in Israel were evaluated. We compared demographics, presentation, laboratory results, imaging, treatment, and outcomes between patients with and without biliary stricture. Multivariate regression analyses were used to identify risk factors for biliary strictures.ResultsAmong 121 pediatric liver transplant patients, 65 (53.7%) were males; the median age at the time of liver transplantation was 43 (3–215) months. Fifteen patients (12.4%) had biliary strictures following transplantation. One (7%) patient with biliary stricture was treated via endoscopic retrograde cholangiopancreatography, and 12 patients (80%) underwent interventions via a percutaneous transhepatic approach. Nine of the 12 patients were treated successfully, requiring one or multiple procedures, while the remaining had surgery or laser therapy. Risk factors for the development of biliary strictures were biliary leak, acute cellular rejection, and the presence of two biliary anastomoses.ConclusionsIn our cohort, the presence of two biliary anastomoses and post‐transplant complications including acute cellular rejection and early biliary leaks were associated with biliary strictures in pediatric liver transplantation recipients. Percutaneous transhepatic interventions result in good outcomes in most patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%