Diagnosis and management of biliary complications in pediatric living donor liver transplant recipients

Citations Over TimeTop 10% of 2014 papers

Abstract

The incidence of biliary complications (BCs) after living donor liver transplantation (LDLT) can reach 40%. Published data on the pediatric population are limited, and treatment protocols vary. Our aim was to describe the clinical scenario for BCs and treatment approaches after LDLT. Between October 1995 and December 2012, 489 pediatric LDLT procedures were performed. BCs developed in 71 patients (14.5%). Biliary strictures (BSs) developed in 45 (9.2%) patients, and bile leaks (BLs) developed in 33 patients (6.7%). The BL diagnosis was clinical in all cases, and 69.7% of the patients underwent surgery. Nearly half of the BS cases had clinical features or suggestive ultrasound findings. Liver biopsy findings suggested BSs in 51.7%. Percutaneous transhepatic cholangiography was performed in 95.6% of the BS patients. The success rate was 77% [mean number of percutaneous biliary interventions (PBIs) = 3.9 ± 1.98, median drainage time = 8 months]. In conclusion, BL patients can be managed with conservative therapy, even though most of these patients will ultimately be treated with surgery. Diagnosing a BS requires a high degree of clinical suspicion because the available resources for its identification can fail in up to 50% of cases. A higher number of PBIs and the use of a drainage catheter for a longer time may be required to achieve better results with this technique.

Related Papers

• → Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial(2020)84 cited
• → Efficacy and safety of a new disposable percutaneous positioning device invented to facilitate the precision of percutaneous core needle lung biopsies: a prospective, open and randomized controlled study(2021)4 cited
• → Lack of agreement for defining ‘clinical suspicion of rejection’ in liver transplantation: a model to select candidates for liver biopsy(2015)30 cited
• → Percutaneous closure of a postoperative residual atrial septal defect(2017)1 cited
• → Comparative clinical study of percutaneous and peratrial device closure of secundum atrial septal defects under single transesophageal echocardiographic guidance(2014)