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Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage-A Case
Michael Doppler1, Christin Fürnstahl2, Simone Hammer1,2
1Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
Insights
Percutaneous transhepatic biliary drainage (PTBD) effectively manages bile leaks after pediatric liver transplantation (pLT). This minimally invasive approach achieved a 100% success rate and excellent patient survival, making it a valuable treatment option.
Area of Science:
- Hepatology
- Pediatric Surgery
- Interventional Radiology
Background:
- Biliary leaks are a serious complication following pediatric liver transplantation (pLT).
- Effective management of post-transplant biliary leaks remains a clinical challenge.
Purpose of the Study:
- To evaluate the outcomes of percutaneous transhepatic biliary drainage (PTBD) for treating bile leaks in children post-pLT.
- To assess the need for additional bilioma drainage and analyze laboratory parameter changes during and after PTBD therapy.
Main Methods:
- A retrospective single-center study included all children undergoing PTBD for biliary leaks post-pLT.
- Analysis focused on leak site, bilioma management, treatment response, and patient/transplant survival.
- Inflammation, cholestasis parameters, and liver enzymes were retrospectively reviewed.
Main Results:
- Ten children received PTBD for post-pLT bile leaks, with most leaks occurring at the hepaticojejunostomy.
- PTBD treatment, initiated on average 40.3 days post-transplant, lasted a mean of 109.7 days.
- Eight patients required additional bilioma drainage; all bile leaks were successfully treated without complications, achieving 100% patient and transplant survival.
- Significant reductions in CRP, leukocyte count, GGT, and bilirubin levels were observed during treatment, with sustained GGT reduction during follow-up.
Conclusions:
- Percutaneous transhepatic biliary drainage (PTBD) is a highly successful therapeutic strategy for managing bile leaks after pediatric liver transplantation (pLT).
- PTBD offers a safe and effective solution with excellent patient outcomes.
Background:
Biliary leaks are a severe complication after pediatric liver transplantation (pLT), and successful management is challenging.
Objectives:
The aim of this case series was to assess the outcome of percutaneous transhepatic biliary drainage (PTBD) in children with bile leaks following pLT. The necessity of additional percutaneous bilioma drainage and laboratory changes during therapy and follow-up was documented.
Material And Methods:
All children who underwent PTBD for biliary leak following pLT were included in this consecutive retrospective single-center study and analyzed regarding site of leak, management of additional bilioma, treatment response, and patient and transplant survival. The courses of inflammation, cholestasis parameters, and liver enzymes were retrospectively reviewed.
Results:
Ten children underwent PTBD treatment for biliary leak after pLT. Seven patients presented with leakage at the hepaticojejunostomy, two with leakage at the choledocho-choledochostomy and one with a bile leak because of an overlooked segmental bile duct. In terms of the mean, the PTBD treatment started 40.3 ± 31.7 days after pLT. The mean duration of PTBD treatment was 109.7 ± 103.6 days. Additional percutaneous bilioma drainage was required in eight cases. Bile leak treatment was successful in all cases, and no complications occurred. The patient and transplant survival rate was 100%. CRP serum level, leukocyte count, gamma-glutamyl transferase (GGT), and total and direct bilirubin level decreased significantly during treatment with a very strong effect size. Additionally, the gamma-glutamyl transferase level showed a statistically significant reduction during follow-up.
Conclusions:
PTBD is a very successful strategy for bile leak therapy after pLT.
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