Percutaneous Treatment of Biliary Complications in Pediatric Patients After Liver Transplantation

Abstract

Purpose: Evaluation of the efficiency and safety of the percutaneous treatment of biliary complications in pediatric liver transplant recipients.

Methods: We conducted a retrospective analysis of children who underwent biliary percutaneous interventions after pediatric liver transplantation (PLT) over a 4-year period. Kind of biliary complication, interval between liver transplantation and intervention, status of the vessels, procedural interventional management, technical and clinical success, course of cholestasis, PTBD-related complications and patient survival were analyzed.

Results: 23 percutaneous transhepatic biliary drainages (PTBD) were placed in 16 children due to 18 biliary complications. The drains were customized individually by shortening and cutting additional holes. PTBD placement was performed with technical and clinical success in all children. 4 children received PTBD to bridge the time to retransplantation and surgical revision. One child received PTBD for successful treatment of anastomotic leakage. Long-term dilation of biliary stenoses was performed in 13 children using PTBD. One of these 13 patients showed recurrent stenosis during a median follow-up of 295 days. Bilirubin values decreased significantly after PTBD placement for biliary stenosis. One patient suffered from bacteremia after PTBD replacement.

Conclusion: PTBD treatment for biliary complications after PLT is effective and safe.

Key points: Various biliary complications after PLT can be successfully treated by PTBD. For this purpose, a highly individualized approach with catheter modification is mandatory.

Citation Format:

• Uller W, Wohlgemuth WA, Hammer S et al. Percutaneous Treatment of Biliary Complications in Pediatric Patients After Liver Transplantation. Fortschr Röntgenstr 2014; 186: 1127 – 1133

Zusammenfassung

Ziel: Evaluation von Effizienz und Sicherheit der perkutanen Therapie biliärer Komplikationen bei Kindern nach Lebertransplantation.

Methoden: Von Juni 2008 bis August 2012 wurden alle perkutanen biliären Interventionen nach pädiatrischer Lebertransplantation (PLT) evaluiert. Hierzu wurde Art der biliären Komplikation, Zeitintervall zwischen PLT und Intervention, Gefäßstatus, interventionelles Vorgehen, technischer und klinischer Erfolg, interventions-bedingte Komplikationen und Überleben analysiert.

Ergebnisse: 23 perkutane transhepatische Cholangiodrainagen (PTCD) wurden bei 16 Kindern wegen insgesamt 18 biliären Komplikationen nach PLT angelegt. Die Drainagen wurden individuell für jedes Kind durch Kürzen und Einbringen von zusätzlichen Löchern modifiziert. Mittels PTCD konnte in 4 Fällen erfolgreich die Zeit bis zur Re-transplantation oder chirurgischen Revision überbrückt werden. In einem Fall konnte eine Insuffizienz der biliodigestiven Anastomose erfolgreich behandelt werden. Eine Langzeitdilatation der biliodigestiven Anastomose wegen Stenosierung wurde bei 13 Kindern mittels PTCD durchgeführt, wobei ein Kind eine Rezidivstenosierung während des follow-ups (median 295 Tage) zeigte. Die Bilirubinwerte sanken nach PTCD-Behandlung signifikant. Bei einem Kind kam es zu einer Bakteriämie nach Drainagewechsel.

Zusammenfassung: Die perkutane transhepatische Therapie biliärer Komplikationen nach PLT ist effektiv und sicher.

Kernaussage: Mittels perkutaner transhepatischer Cholangiodrainage können unterschiedliche biliäre Komplikationen nach PLT erfolgreich behandelt werden. Hierbei ist allerdings ein individualisiertes, auf jeden Patienten abgestimmtes Vorgehen, unter Modifikation der Drainagen, nötig.

Key words

bile ducts - bile duct radiography - percutaneous - catheters - cholangitis - transplantation

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