Pediatric Patients after Liver Transplant: A Summary of Biliary Complications and Interventions
22 March 2018 (online)
Purpose To review biliary complications after liver transplant in pediatric patients, the percutaneous interventions performed, and the length of time to surgery after intervention.
Materials and Methods A single center retrospective review was performed on 32 pediatric patients with liver transplants (age range 7–37 months). The type of complication, type of biliary intervention, length of catheter dwell time, and the length of time between catheter placement and surgery were all evaluated.
Results Of the 32 patients with liver transplants requiring intervention, 7/32 had bile leak, 27/32 had stricture, and 1/32 had stones. The interventions performed were as follows: endoscopic retrograde cholangiopancreatography (ERCP) (4/32), percutaneous transhepatic biliary drain (PTBD) placement (23/32), biloma catheter placement (4/32), balloon dilatation (1/32), and percutaneous transhepatic cholecystostomy (PTC) tube placement (1/32). Of the patients with catheter placement, the average length of time to catheter removal was 6 weeks (range: 1 day to 23 weeks). Surgery was performed in 18/32 patients. Fourteen out of 18 patients had surgery at the time of catheter removal. One patient had surgery 2 months after ERCP. The remaining three patients had surgery ranging from 2 months to 4 years after the catheter removal.
Conclusion Using percutaneous interventions to treat biliary complications allows vital time for growth and in some patients obviates the need for surgery in the pediatric liver transplant population.