Subclinical biliary strictures as a cause of long-term allograft dysfunction in children who underwent liver transplantation

Abstract

The long-term outcome of liver grafts in children following liver transplantation (LT) is unknown. Grafts transplanted into children are meant to survive for long time, hence a number of centers started to perform routine protocol biopsies to detect any type of graft injury at an early stage. 1 However, the focus so far has been placed on graft hepatitis and fibrosis, most likely because of immune reactions against the transplanted organ. 2 Indeed, although liver biopsy is widely considered an essential tool to identify the pathogenesis of graft dysfunction, histological features of biliary obstruction may have not been given sufficient attention so far, in contrast to inflammatory changes. Biliary complications are a major source of morbidity after LT, and their reported incidence varies between 5% and 20% in children. 3 This might be because of different surgical techniques adopted across pediatric LT centers but may also reflect a different

Incidence of Cholangitis and Sepsis Associated with Percutaneous Transhepatic Cholangiography in Pediatric Liver Transplant Recipients

“…PTC was performed in case of elevated alanine aminotransferase (ALT) or gamma glutamyl transpeptidase (GGT) and/or history of cholangitis and/or liver biopsy consistent with cholangiolar proliferation. Remarkably, in a few cases, PTC was done even in absence of biochemical abnormalities based on evidence of isolated and significant cholangiolar proliferation at liver biopsy [ 2 ]. One hour before the procedure, all patients received iv antibiotics classified into first- and second-line prophylaxis.…”

“…Biliary complications are a major source of morbidity after liver transplant (LT), and their reported incidence varies between 5 and 20% in children [ 1 , 2 ]. If properly managed, biliary complications are thought not to affect significantly patient and graft survival [ 3 ].…”

Impact of different ischemia times on biliary stricture after living donor liver transplantation with biliary atresia

“…Biliary atresia (BA) is the most common indication for pediatric liver transplantation 1. With advances in techniques for pediatric living donor liver transplantation (LDLT), recipient and graft survival rates have improved significantly, but biliary stricture (BS) remains an Achilles’ heel for pediatric LDLT 2–4. The incidence of BS after pediatric LDLT has been reported to be 10%–35% 2,5,6.…”

“…[1] With advances in techniques for pediatric living donor liver transplantation (LDLT), recipient and graft survival rates have improved significantly, but biliary stricture (BS) remains an Achilles' heel for pediatric LDLT. [2][3][4] The incidence of BS after pediatric LDLT has been reported to be 10%-35%. [2,5,6] Some of them were difficult to treat, and this can lead to graft loss or even death.…”

Developments in diagnosis and management of post-liver transplantation biliary complications: the radiologist’s perspective

“…The suspicion and diagnosis of a biliary stricture should be clinical in the first instance, because the onset of imaging-detectable bile duct dilation may develop only in later stages or may not occur in case of fibrotic and poorly elastic liver parenchyma. Nevertheless, Sansotta et al (7) observed that biliary strictures can be clinically and biochemically silent and only incidentally detected in liver biopsies performed in the routine follow-up of orthotopic liver transplantation. The mechanisms of poor clinical manifestation of biliary strictures are not clearly understood yet; a possible hypothesis, on which we are investigating, implies that biliary drainage may be compensated through lymphatic pathways (Figure 1).…”