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Infectious Complications After Percutaneous Transhepatic Biliary Drainage in Pediatric Liver Transplant Recipients
Isaline Chabbey1,2, Federico Barooty3, Ana M Calinescu1,4
1Swiss Pediatric Liver Center, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.
Insights
Percutaneous transhepatic biliary drainage (PTBD) in pediatric liver transplant recipients is linked to frequent infectious complications. Extended 24-hour antibiotic prophylaxis may reduce these PTBD complications.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Transplant Surgery
Background:
- Percutaneous transhepatic biliary drainage (PTBD) is crucial for managing biliary complications post-pediatric liver transplant (LT).
- Limited data exist on infection rates and optimal antibiotic prophylaxis following PTBD in this population.
- This study aimed to analyze PTBD complications and associated factors in pediatric LT recipients.
Purpose of the Study:
- To evaluate the incidence and types of complications following PTBD in pediatric LT recipients.
- To identify factors associated with PTBD complications, particularly infectious ones.
- To assess the impact of antibiotic prophylaxis duration on post-PTBD infection rates.
Main Methods:
- Retrospective review of medical records for pediatric LT patients between August 2004 and October 2020.
- Selection of patients who developed biliary complications treated with PTBD.
- Comparison of PTBD outcomes between patients with and without complications, and analysis of antibiotic prophylaxis strategies.
Main Results:
- 35 PTBD sessions were performed in 11 pediatric LT recipients; anastomotic stricture was the most common finding.
- Nearly half of PTBD sessions (49%) resulted in complications, primarily infectious (40%).
- A trend suggested lower infection rates with extended 24-hour antibiotic therapy (10%) compared to one-day prophylaxis (52%).
Conclusions:
- PTBD in pediatric LT recipients is associated with a high rate of post-procedure infectious complications.
- These infectious complications contribute significantly to patient morbidity.
- Extended 24-hour antibiotic prophylaxis showed a trend towards reducing infectious complications after PTBD.
Background:
The gold-standard for the diagnosis and management of biliary complications, particularly biliary strictures in pediatric liver transplant (LT) recipients is percutaneous transhepatic cholangiogram (PTC) followed by biliary drainage (PTBD). Despite the established role of PTBD in managing biliary complications in pediatric LT recipients, limited data exist on post-procedural infection rates and optimal antibiotic prophylaxis strategies. The primary aim was to analyze the complications of PTBD in pediatric LT recipients. The secondary aim was to analyze factors associated with PTBD complications.
Methods:
We retrospectively reviewed the medical records of children having undergone LT between August 2004 and October 2020 in our center. Patients who developed a biliary complication treated by PTBD were selected. We then compared PTBD patients with complications to those without.
Results:
Eleven patients underwent 35 percutaneous transhepatic biliary drainage (PTBD) sessions. Biliary atresia was the most frequent indication for LT in 6/11 (54%) children. Ten (10/11; 91%) received a left lateral segment, and all had undergone biliary-enteric anastomosis. Anastomotic stricture was the most common finding on PTC in 22/35 (63%) sessions. 25/35 (71%) PTBD were conducted using one-day antibiotic prophylaxis and 10/35 (29%) using extended-24-h antibiotherapy. Of 35 PTBD sessions, 17/35 (49%) experienced complications, primarily infectious (40%; 14/35). We compared different antibioprophylaxis regimens in 14 PTBD with infection. There was a trend to a lower incidence of infections in the extended-24-h antibiotherapy group (10%; 1/10) compared to the one-day antibiotic prophylaxis group (52%; 13/25) with a relative risk of 0.19 (0.03-1.28).
Conclusions:
PTBD is associated with a high rate of post-procedure infectious complications. These complications result in a high burden and morbidity. There was a trend to an association between extended-24-h antibiotherapy and the absence of infectious complications after PTBD.
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