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

Pediatr Radiol. 2022 May;52(6):1061-1074. doi: 10.1007/s00247-021-05278-3. Epub 2022 Feb 2.

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.

Keywords: Biliary; Children; Complications; Interventional radiology; Liver; Percutaneous transhepatic cholangiography; Transplantation.

MeSH terms

  • Adolescent
  • Catheterization / adverse effects
  • Child
  • Cholangiography
  • Cholestasis*
  • Humans
  • Liver Transplantation* / adverse effects
  • Postoperative Complications / diagnostic imaging
  • Retrospective Studies