Abstract
Purpose
To assess the efficacy of percutaneous techniques in managing paediatric liver transplantation complications.
Material and Methods
We carried out 105 paediatric cadaveric donor liver transplantations at our centre from 2001 to 2018. Percutaneous techniques were used to treat 25 cases involving transplantation complications in 23 patients. Biliary complications were treated in 14 cases (13.3%): 10 patients had bile duct obstruction, and 4 had biliary leaks. Vascular complications were treated in 11 cases (10.5%): 5 hepatic artery (HA) stenoses/occlusions, 2 inferior vena cava (IVC) stenoses, and 1 portal vein (PV) stenosis. Other interventions involved embolisation of the superior mesenteric artery branch to manage gastrointestinal bleeding in 2 patients and embolisation of an arteriobiliary fistula in 1 patient.
Results
Biliary: We carried out external–internal drainage and balloon dilatation of stenoses in 12 cases. The external–internal drainage catheter was removed after 6–8 weeks in 7 patients, with the remaining 5 patients with persisting stenosis assigned for retransplantation. We failed to cross anastomotic occlusions in 2 patients before completing the procedures using external drainage; both individuals subsequently underwent retransplantation. Vascular: We performed PTA/stenting of HA stenoses/occlusions in 4 out of 5 patients. After the procedure, all 4 patients showed liver function normalisation. All 3 cases of embolisation were technically and clinically successful. Both IVC and PV stenoses treated with dilatation/stenting were also successful.
Conclusions
Percutaneous techniques used to treat biliary and vascular complications after liver transplantation in paediatric patients are safe and efficient.
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Change history
04 March 2020
In the original article, the following author name was incorrectly published and the corrected name is given below.
References
Bucuvalas J. Long-term outcomes in pediatric liver transplantation. Liver Transpl. 2009;15(Suppl 2):S6–11.
Bekker J, Ploem S, de Jong KP. Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Am J Transplant. 2009;9(4):746–57.
Duffy JP, Hong JC, Farmer DG, Ghobrial RM, Yersiz H, Hiatt JR, Busuttil RW. Vascular complications of orthotopic liver transplantation: experience in more than 4200 patients. J Am Coll Surg. 2009;208(5):896–903 discussion 903–5.
Karakayalı F, Kırnap M, Akdur A, Tutar N, Boyvat F, Moray G, Haberal M. Biliary complications after pediatric liver transplantation. Transplant Proc. 2013;45(10):3524–7.
Laurence JM, Sapisochin G, DeAngelis M, Seal JB, Miserachs MM, Marquez M, Zair M, Fecteau A, Jones N, Hrycko A, Avitzur Y, Ling SC, Ng V, Cattral M, Grant D, Kamath BM, Ghanekar A. Biliary complications in pediatric liver transplantation: Incidence and management over a decade. Liver Transpl. 2015;21(8):1082–90.
Diamond IR, Fecteau A, Millis JM, Losanoff JE, Ng V, Anand R, Song C, SPLIT Research Group. Impact of graft type on outcome in pediatric liver transplantation: a report from Studies of Pediatric Liver Transplantation (SPLIT). Ann Surg. 2007;246(2):301-10.
Seehofer D, Eurich D, Veltzke-Schlieker W, Neuhaus P. Biliary complications after liver transplantation: old problems and new challenges. Am J Transplant. 2013;13(2):253–65.
Wojcicki M, Silva MA, Jethwa P, Gunson B, Bramhall SR, Mayer D, Buckels JA, Mirza DF. Biliary complications following adult right lobe ex vivo split liver transplantation. Liver Transpl. 2006;12(5):839–44.
Keogan MT, McDermott VG, Price SK, Low VH, Baillie J. The role of imaging in the diagnosis and management of biliary complications after liver transplantation. AJR Am J Roentgenol. 1999;173(1):215–9.
Wang SF, Huang ZY, Chen XP. Biliary complications after living donor liver transplantation. Liver Transpl. 2011;17(10):1127–36.
Vagefi PA, Parekh J, Ascher NL, Roberts JP, Freise CE. Outcomes with split liver transplantation in 106 recipients: The University of California, San Francisco, experience from 1993 to 2010. Arch Surg. 2011;146(9):1052–9.
Darius T, Rivera J, Fusaro F, Lai Q, de Magnée C, Bourdeaux C, Janssen M, Clapuyt P, Reding R. Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation. Liver Transpl. 2014;20(8):893–903.
Kamran S, Mirzakhani H, Eslami M, Saidi RF. Current state of the art in management of vascular complications after pediatric liver transplantation. Pediatr Transplant. 2015;19(1):18–26.
Sieders E, Peeters PM, TenVergert EM, de Jong KP, Porte RJ, Zwaveling JH, Bijleveld CM, Slooff MJ. Early vascular complications after pediatric liver transplantation. Liver Transpl. 2000;6(3):326–32.
Porrett PM, Hsu J, Shaked A. Late surgical complications following liver transplantation. Liver Transpl. 2009;15(Suppl 2):S12–S1818.
Carnevale FC, de Tarso MA, Moreira AM, Dos Santos AC, da MottaLealFilho JM, Suzuki L, Cerri GG, Tannuri U. Long-term results of the percutaneous transhepatic venoplasty of portal vein stenoses after pediatric liver transplantation. Pediatr Transplant. 2011;15(5):476–81.
Uller W, Knoppke B, Schreyer AG, Heiss P, Schlitt HJ, Melter M, Stroszczynski C, Zorger N, Wohlgemuth WA. Interventional radiological treatment of perihepatic vascular stenosis or occlusion in pediatric patients after liver transplantation. Cardiovasc Intervent Radiol. 2013;36(6):1562–71.
Buell JF, Funaki B, Cronin DC, Yoshida A, Perlman MK, Lorenz J, Kelly S, Brady L, Leef JA, Millis JM. Long-term venous complications after full-size and segmental pediatric liver transplantation. Ann Surg. 2002;236(5):658–66.
Abad J, Hidalgo EG, Cantarero JM, Parga G, Fernandez R, Gomez M, Colina F, Moreno E. Hepatic artery anastomotic stenosis after transplantation: treatment with percutaneous transluminal angioplasty. Radiology. 1989;171(3):661–2.
Sunku B, Salvalaggio PR, Donaldson JS, Rigsby CK, Neighbors K, Superina RA, Alonso EM. Outcomes and risk factors for failure of radiologic treatment of biliary strictures in pediatric liver transplantation recipients. Liver Transpl. 2006;12(5):821–6.
Moreira AM, Carnevale FC, Tannuri U, Suzuki L, Gibelli N, Maksoud JG, Cerri GG. Long-term results of percutaneous bilioenteric anastomotic stricture treatment in liver-transplanted children. Cardiovasc Intervent Radiol. 2010;33(1):90–6.
Chok KS, Chan SC, Chan KL, Sharr WW, Tam PK, Fan ST, Lo CM. Bile duct anastomotic stricture after pediatric living donor liver transplantation. J Pediatr Surg. 2012;47(7):1399–403.
Haberal M, Karakayali H, Atiq A, Sevmis S, Moray G, Ozcay F, Boyvat F. Duct-to-duct biliary reconstruction without a stent in pediatric living-donor liver transplantation. Transplant Proc. 2011;43(2):595–7.
Feier FH, Seda-Neto J, da Fonseca EA, Candido HL, Pugliese RS, Neiva R, Benavides MR, Chapchap P. Analysis of factors associated with biliary complications in children after liver transplantation. Transplantation. 2016;100(9):1944–54.
Sawyer RG, Punch JD. Incidence and management of biliary complications after 291 liver transplants following the introduction of transcystic stenting. Transplantation. 1998;66(9):1201–7.
Righi D, Franchello A, Ricchiuti A, Breatta AD, Versace K, Calvo A, Romagnoli R, Fonio P, Gandini G, Salizzoni M. Safety and efficacy of the percutaneous treatment of bile leaks in hepaticojejunostomy or split-liver transplantation without dilatation of the biliary tree. Liver Transpl. 2008;14(5):611–5.
Singhal A, Stokes K, Sebastian A, Wright HI, Kohli V. Endovascular treatment of hepatic artery thrombosis following liver transplantation. Transpl Int. 2010;23(3):245–56.
PérezSaborido B, PachecoSánchez D, BarreraRebollo A, AsensioDíaz E, PintoFuentes P, SarmenteroPrieto JC, RodríguezVielba P, MartínezDíaz R, GonzaloMartín M, Rodríguez M, CaleroAguilar H, PintadoGarrido R, GarcíaPajares F, AntaRomán A. Incidence, management, and results of vascular complications after liver transplantation. Transplant Proc. 2011;43(3):749–50.
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Peregrin, J.H., Kováč, J., Prchlík, M. et al. Interventional Radiological Treatment of Paediatric Liver Transplantation Complications. Cardiovasc Intervent Radiol 43, 765–774 (2020). https://doi.org/10.1007/s00270-020-02430-8
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DOI: https://doi.org/10.1007/s00270-020-02430-8