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Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage—A Case Series

Background: Biliary leaks are a severe complication after pediatric liver transplantation (pLT), and successful management is challenging. Objectives: The aim of this case series was to assess the outcome of percutaneous transhepatic biliary drainage (PTBD) in children with bile leaks following pLT....

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Autores principales: Doppler, Michael, Fürnstahl, Christin, Hammer, Simone, Melter, Michael, Verloh, Niklas, Schlitt, Hans Jürgen, Uller, Wibke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10610565/
https://www.ncbi.nlm.nih.gov/pubmed/37888745
http://dx.doi.org/10.3390/tomography9050153
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author Doppler, Michael
Fürnstahl, Christin
Hammer, Simone
Melter, Michael
Verloh, Niklas
Schlitt, Hans Jürgen
Uller, Wibke
author_facet Doppler, Michael
Fürnstahl, Christin
Hammer, Simone
Melter, Michael
Verloh, Niklas
Schlitt, Hans Jürgen
Uller, Wibke
author_sort Doppler, Michael
collection PubMed
description Background: Biliary leaks are a severe complication after pediatric liver transplantation (pLT), and successful management is challenging. Objectives: The aim of this case series was to assess the outcome of percutaneous transhepatic biliary drainage (PTBD) in children with bile leaks following pLT. The necessity of additional percutaneous bilioma drainage and laboratory changes during therapy and follow-up was documented. Material and Methods: All children who underwent PTBD for biliary leak following pLT were included in this consecutive retrospective single-center study and analyzed regarding site of leak, management of additional bilioma, treatment response, and patient and transplant survival. The courses of inflammation, cholestasis parameters, and liver enzymes were retrospectively reviewed. Results: Ten children underwent PTBD treatment for biliary leak after pLT. Seven patients presented with leakage at the hepaticojejunostomy, two with leakage at the choledocho-choledochostomy and one with a bile leak because of an overlooked segmental bile duct. In terms of the mean, the PTBD treatment started 40.3 ± 31.7 days after pLT. The mean duration of PTBD treatment was 109.7 ± 103.6 days. Additional percutaneous bilioma drainage was required in eight cases. Bile leak treatment was successful in all cases, and no complications occurred. The patient and transplant survival rate was 100%. CRP serum level, leukocyte count, gamma-glutamyl transferase (GGT), and total and direct bilirubin level decreased significantly during treatment with a very strong effect size. Additionally, the gamma-glutamyl transferase level showed a statistically significant reduction during follow-up. Conclusions: PTBD is a very successful strategy for bile leak therapy after pLT.
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spelling pubmed-106105652023-10-28 Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage—A Case Series Doppler, Michael Fürnstahl, Christin Hammer, Simone Melter, Michael Verloh, Niklas Schlitt, Hans Jürgen Uller, Wibke Tomography Article Background: Biliary leaks are a severe complication after pediatric liver transplantation (pLT), and successful management is challenging. Objectives: The aim of this case series was to assess the outcome of percutaneous transhepatic biliary drainage (PTBD) in children with bile leaks following pLT. The necessity of additional percutaneous bilioma drainage and laboratory changes during therapy and follow-up was documented. Material and Methods: All children who underwent PTBD for biliary leak following pLT were included in this consecutive retrospective single-center study and analyzed regarding site of leak, management of additional bilioma, treatment response, and patient and transplant survival. The courses of inflammation, cholestasis parameters, and liver enzymes were retrospectively reviewed. Results: Ten children underwent PTBD treatment for biliary leak after pLT. Seven patients presented with leakage at the hepaticojejunostomy, two with leakage at the choledocho-choledochostomy and one with a bile leak because of an overlooked segmental bile duct. In terms of the mean, the PTBD treatment started 40.3 ± 31.7 days after pLT. The mean duration of PTBD treatment was 109.7 ± 103.6 days. Additional percutaneous bilioma drainage was required in eight cases. Bile leak treatment was successful in all cases, and no complications occurred. The patient and transplant survival rate was 100%. CRP serum level, leukocyte count, gamma-glutamyl transferase (GGT), and total and direct bilirubin level decreased significantly during treatment with a very strong effect size. Additionally, the gamma-glutamyl transferase level showed a statistically significant reduction during follow-up. Conclusions: PTBD is a very successful strategy for bile leak therapy after pLT. MDPI 2023-10-19 /pmc/articles/PMC10610565/ /pubmed/37888745 http://dx.doi.org/10.3390/tomography9050153 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Doppler, Michael
Fürnstahl, Christin
Hammer, Simone
Melter, Michael
Verloh, Niklas
Schlitt, Hans Jürgen
Uller, Wibke
Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage—A Case Series
title Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage—A Case Series
title_full Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage—A Case Series
title_fullStr Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage—A Case Series
title_full_unstemmed Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage—A Case Series
title_short Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage—A Case Series
title_sort biliary leak after pediatric liver transplantation treated by percutaneous transhepatic biliary drainage—a case series
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10610565/
https://www.ncbi.nlm.nih.gov/pubmed/37888745
http://dx.doi.org/10.3390/tomography9050153
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