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Treatment Strategies for Bile Leak Following Pediatric Liver Transplantation

João Seda Neto1,2, Carolina M Costa1,2, André M de Assis3

  • 1Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.

Pediatric Transplantation
|June 19, 2024
PubMed

Insights

Standard management for bile leak (BL) after pediatric liver transplantation (LT) is lacking. Observation is associated with lower bilirubin levels, while percutaneous transhepatic cholangiography (PTC) may increase biliary stricture risk.

Area of Science:

  • Hepatology
  • Transplantation Surgery
  • Pediatric Gastroenterology

Background:

  • Bile leak (BL) is a complication following liver transplantation (LT).
  • Standardized management protocols for BL after pediatric LT are currently unavailable.
  • This study addresses the need for evidence-based treatment strategies.

Purpose of the Study:

  • To describe and compare treatment options for BL in pediatric LT recipients.
  • To analyze outcomes associated with different management strategies for BL.
  • To identify factors influencing treatment success and complications.

Main Methods:

  • Retrospective analysis of pediatric LT cases from January 2010 to March 2023.
  • Categorization of patients into four treatment groups: observation, percutaneous transhepatic cholangiography (PTC), ERCP, and surgery.
  • Analysis of preoperative data, diagnostic status, and postoperative outcomes.

Main Results:

  • Out of 931 pediatric LTs, 78 (8.3%) developed BL, exclusively in living donor liver transplants (LDLT).
  • Observation group showed significantly lower peritoneal bilirubin (PB) and fluid-to-serum bilirubin ratio (FSBR) levels.
  • Percutaneous transhepatic cholangiography (PTC) was associated with higher rates of biliary stricture (52.6%) compared to surgery (18.5%).

Conclusions:

  • Observation may be a viable initial approach for BL in select pediatric LT patients, indicated by lower PB and FSBR.
  • Percutaneous transhepatic cholangiography (PTC) is linked to increased risk of post-treatment biliary stricture.
  • Further research is needed to establish optimal BL management protocols in pediatric LT.

Keywords:
bile leakchildrencomplicationsliving donoroutcomes

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