Percutaneous interventional management of biliary complications after pediatric liver transplantation: A 16-year...

Area of Science:

• Hepatobiliary Surgery
• Transplant Surgery
• Interventional Radiology

Background:

• Biliary complications (BiCx) are a significant concern following pediatric liver transplantation (OLT).
• Biliary leaks (BL) and biliary strictures (BS) are common types of BiCx requiring management.
• The efficacy of different treatment modalities for BiCx after OLT needs thorough investigation.

Purpose of the Study:

• To investigate biliary complications (BiCx) occurring after pediatric liver transplantation (OLT).
• To assess the efficacy of fluoroscopic-guided percutaneous biliary intervention (PBI) compared to surgical re-exploration (SR) in managing BiCx.
• To evaluate graft revision, graft loss, and survival rates following PBI and SR for BS and BL.

Main Methods:

• Retrospective analysis of 340 OLTs performed in 302 patients over 16 years.
• Inclusion criteria: presence of biliary strictures (BS) or biliary leaks (BL) post-OLT.
• Comparison of outcomes (graft revision, loss, survival) between PBI and SR for BiCx management.

Main Results:

• Biliary complications (BiCx) occurred in 17.1% of OLTs; 6.2% had biliary leaks (BL) and 12.7% had biliary strictures (BS).
• One- and 3-year graft survival rates for OLT with BL treated by PBI were 75.0% and 68.8%, compared to 75% and 66.7% with SR (P>.05).
• One- and 3-year graft survival rates for OLT with BS treated by PBI were 70.6% and 54.5%, compared to 71.4% and 50% with SR/ERCP (P>.05).

Conclusions:

• Fluoroscopic-guided percutaneous biliary intervention (PBI) is as effective as surgical re-exploration (SR) for managing biliary leaks (BL) after pediatric liver transplantation (OLT).
• PBI demonstrates comparable efficacy to SR/ERCP in treating biliary strictures (BS) following pediatric OLT.
• Both PBI and SR are viable treatment options for biliary complications after pediatric liver transplantation, with similar graft survival outcomes.