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Imaging of biliary complications following paediatric liver transplantation
1Department of Radiology, Birmingham Children's Hospital NHS Trust, Ladywood Middleway, Birmingham B16 8ET, UK.
Insights
Biliary complications are common after pediatric liver transplants, affecting 25% of patients. Early detection using ultrasound and cholangiography is crucial for managing these issues, with most occurring within two weeks post-transplant.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Biliary complications (BC) are a significant concern following pediatric liver transplantation.
- Understanding the incidence and presentation of BC is vital for improving patient outcomes.
Purpose of the Study:
- To retrospectively analyze the incidence, types, and timing of biliary complications in pediatric liver transplant recipients.
- To evaluate the diagnostic utility of imaging modalities in detecting BC post-transplantation.
Main Methods:
- Retrospective review of 169 consecutive pediatric liver transplants in 139 children.
- Analysis of complication types (obstruction, leakage, combined) and their presentation.
- Assessment of imaging modalities including ultrasound and cholangiography for BC detection.
Main Results:
- Biliary complications occurred in 25% of patients (36/169 grafts, 21%).
- Biliary obstruction (11%) and leakage (8%) were the most common BC types.
- Most BC (72%) presented within the first two weeks post-transplant.
- Ultrasound and cholangiography were primary diagnostic tools, though false negatives were noted.
Conclusions:
- Biliary complications are frequent after pediatric liver transplantation and often manifest early.
- Ultrasound is essential for post-operative surveillance, with cholangiography playing a complementary role.
- Prompt diagnosis and management of BC are critical for successful graft survival in pediatric liver transplant recipients.
Abstract:
Biliary complications (BC) are well recognised following paediatric liver transplantation. We reviewed retrospectively 169 consecutive liver transplants performed in 139 children. BC occurred in 36/169 grafts (21 %) in 35/139 patients (25 %). Biliary obstruction was present in 18/169 grafts (11 %), biliary leakage in 14/169 grafts (8 %) and a combination of obstruction and leakage was present in 4/169 (2 %) grafts. BC were as likely to present radiologically as they were with either clinical and/or biochemical abnormalities. Most BC (26/36, i. e. 72 %) occurred in the first 2 weeks following transplantation. Ultrasound and cholangiography were the principle imaging modalities used for detection of these complications. False negative ultrasound examinations occurred in three patients with biliary obstruction and in three patients with biliary leakage. False negative cholangiograms occurred in two patients with biliary leakage. Ultrasound is important in the post-operative surveillance of paediatric liver transplants, with cholangiography having a complementary role in those with BC.