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

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Tomography Pub Date : 2023-10-19 DOI:10.3390/tomography9050153

Michael Doppler, Christin Fürnstahl, Simone Hammer, Michael Melter, Niklas Verloh, Hans Jürgen Schlitt, Wibke Uller

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引用次数: 0

Abstract

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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经皮肝内胆管引流治疗小儿肝移植术后胆漏——病例系列。

背景：胆道漏是儿童肝移植术后的一种严重并发症，成功的治疗具有挑战性。目的：本系列病例的目的是评估经皮肝穿刺胆道引流术（PTBD）治疗pLT后胆漏儿童的疗效。记录了在治疗和随访期间进行额外经皮胆道瘤引流和实验室改变的必要性。材料和方法：所有在pLT后因胆漏而接受PTBD的儿童都被纳入这项连续的回顾性单中心研究，并就渗漏部位、额外胆管瘤的处理、治疗反应、患者和移植存活率进行分析。对炎症过程、胆汁淤积参数和肝酶进行回顾性分析。结果：10例儿童接受PTBD治疗。7名患者在肝肠造口术中出现渗漏，2名患者在胆总管造口术中发生渗漏，1名患者因忽视节段胆管而出现胆汁渗漏。就平均值而言，PTBD治疗在pLT后40.3±31.7天开始。PTBD治疗的平均持续时间为109.7±103.6天。8例需要额外的经皮胆道瘤引流。所有病例的胆汁渗漏治疗均取得成功，无并发症发生。患者和移植存活率为100%。CRP血清水平、白细胞计数、γ-谷氨酰转移酶（GGT）以及总胆红素和直接胆红素水平在治疗期间显著下降，具有非常强的效应大小。此外，γ-谷氨酰转移酶水平在随访期间显示出统计学意义上的显著降低。结论：PTBD是pLT后胆汁渗漏治疗的一种非常成功的策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Tomography Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

2.70

自引率

10.50%

发文量

222

期刊介绍： TomographyTM publishes basic (technical and pre-clinical) and clinical scientific articles which involve the advancement of imaging technologies. Tomography encompasses studies that use single or multiple imaging modalities including for example CT, US, PET, SPECT, MR and hyperpolarization technologies, as well as optical modalities (i.e. bioluminescence, photoacoustic, endomicroscopy, fiber optic imaging and optical computed tomography) in basic sciences, engineering, preclinical and clinical medicine. Tomography also welcomes studies involving exploration and refinement of contrast mechanisms and image-derived metrics within and across modalities toward the development of novel imaging probes for image-based feedback and intervention. The use of imaging in biology and medicine provides unparalleled opportunities to noninvasively interrogate tissues to obtain real-time dynamic and quantitative information required for diagnosis and response to interventions and to follow evolving pathological conditions. As multi-modal studies and the complexities of imaging technologies themselves are ever increasing to provide advanced information to scientists and clinicians. Tomography provides a unique publication venue allowing investigators the opportunity to more precisely communicate integrated findings related to the diverse and heterogeneous features associated with underlying anatomical, physiological, functional, metabolic and molecular genetic activities of normal and diseased tissue. Thus Tomography publishes peer-reviewed articles which involve the broad use of imaging of any tissue and disease type including both preclinical and clinical investigations. In addition, hardware/software along with chemical and molecular probe advances are welcome as they are deemed to significantly contribute towards the long-term goal of improving the overall impact of imaging on scientific and clinical discovery.