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Wang W, Wang Y, Zhang Y, Zhang W, Bai X, Zhang Q, Liang T. Universal antifungal prophylaxis effectively prevents fungal bloodstream infection in pediatric liver transplant recipients: a retrospective real-world study. Int J Infect Dis 2024; 143:107003. [PMID: 38521451 DOI: 10.1016/j.ijid.2024.107003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/20/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVES Fungal bloodstream infection (fBSI) following pediatric liver transplantation presents a significant challenge; however, there remains a paucity of guidance regarding antifungal prophylaxis in this population. This study aimed to evaluate the effectiveness of universal antifungal prophylaxis and propose a desirable strategy. METHODS We enrolled 604 pediatric patients who underwent liver transplantation between 2020 and 2023, including 242 patients with empirical prophylaxis and 362 patients with universal prophylaxis. Univariate and multivariate logistic regression analyses were performed to identify independent factors for fBSI. RESULTS Eight (2.2%) pediatric recipients in the universal prophylaxis group and 13 (5.4%) in the empirical group developed fBSI (P = 0.038). Universal prophylaxis was a protective factor (P = 0.044), while high-volume intraoperative plasma transfusion and deceased donor liver transplantation were independent risk factors for fBSI (P = 0.035 and 0.008, respectively). Universal antifungal strategy showed an increased overall survival trend after liver transplantation although without significant statistical difference (P = 0.217). Patients with fBSI had poorer survival than those without fBSI (P <0.001). CONCLUSIONS Universal prophylaxis strategy for fBSI in pediatrics after liver transplantation is desirable as it could markedly decrease the occurrence of fBSI. Pediatric patients with deceased donors and high-volume intraoperative transfusion should be paid more attention to preventing fBSI.
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Affiliation(s)
- Weili Wang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yangyang Wang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuntao Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xueli Bai
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
| | - Qi Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China.
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Abraham RR, Zameer MM, Vinay C, Rao S, D’Cruz A. Transplanting Livers in Young Children - Looking Back at 100 Cases. J Indian Assoc Pediatr Surg 2024; 29:192-198. [PMID: 38912017 PMCID: PMC11192256 DOI: 10.4103/jiaps.jiaps_229_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 06/25/2024] Open
Abstract
Introduction Despite advances in medical therapy, liver replacement continues to be the only definitive mode of therapy for children with end-stage liver disease (ESLD). However, its acceptance in India has been discouraging more due to financial and logistic reasons than the availability of expertise. This report outlines our journey and highlights issues pertinent to circumstances in an emerging economy like India. Aim The aim is to review a single center's 100 case experience with liver transplantation (LT). Materials and Methods A prospective analysis of all children who underwent LT since 2005 at our institute was done. The data were collated from a maintained structured database. Results Hundred children underwent LT. Sixty-four were boys. Age ranged from 5 to 144 months, with a median of 17 months. The mean weight of the cohort was 7.5 kg (ranging from 3.7 to 31.5 kg), with 60% of our children weighing between 5 and 10 kg. Biliary atresia is the most common indication (57%); others include metabolic disorders, progressive familial intrahepatic cholestasis, and hepatoblastoma. Two patients were for acute liver failure. Ninety-one children underwent live donor LT (mothers being the majority of the donors). None of the donors had any major postoperative complications. Major intraoperative complications include sepsis (39%), vascular complications (17%), biliary leak (11%), and intestinal complications (11%). Early postoperative deaths occurred in 18% of patients with sepsis being most common cause. The mean follow-up was 8.5 years and the overall survival is 70%. The mean survival is time (months) = 176.1. All surviving patients were followed up and had achieved good catch up growth by 3rd and 5th years posttransplant. The long-term sequalae include recurrent intercurrent infections, graft rejection (9%), posttransplant lymphoproliferative disease (5%), and portal vein stenosis (5%). Conclusion Our experience demonstrates the feasibility of LT in children with ESLD in India. With longer-living grafts, patients often struggle with other issues such as compliance with follow-up, financial issues, recurrent infections, and neurological problems. Close monitoring with regular follow-up of patients helps in early recognition and treatment of late-onset complications, thus helping the overall long-term outcomes.
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Affiliation(s)
- Reya Rachel Abraham
- Department of Paediatric Surgery, Narayana Health City, Bengaluru, Karnataka, India
| | - M. M. Zameer
- Department of Paediatric Surgery, Narayana Health City, Bengaluru, Karnataka, India
| | - C. Vinay
- Department of Paediatric Surgery, Narayana Health City, Bengaluru, Karnataka, India
| | - Sanjay Rao
- Department of Paediatric Surgery, Narayana Health City, Bengaluru, Karnataka, India
| | - Ashley D’Cruz
- Department of Paediatric Surgery, Narayana Health City, Bengaluru, Karnataka, India
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Vingrovich O, Cooper S, Gurevich M, Cohen A, Mozer-Glassberg Y, Bar-Lev MR, Shamir R, Waisbourd-Zinman O. Biliary strictures post pediatric liver transplantation-incidence and risk factors in a single tertiary referral transplant center. Pediatr Transplant 2024; 28:e14727. [PMID: 38613151 DOI: 10.1111/petr.14727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Biliary strictures are a significant cause of morbidity and graft loss in pediatric liver transplant recipients. Risk factors for the development of biliary strictures are not fully established. We aimed to evaluate the incidence of biliary strictures and treatment modalities outcomes and to identify potential risk factors for occurrence. METHODS Pediatric patients who underwent liver transplantation in the single tertiary pediatric liver transplant center in Israel were evaluated. We compared demographics, presentation, laboratory results, imaging, treatment, and outcomes between patients with and without biliary stricture. Multivariate regression analyses were used to identify risk factors for biliary strictures. RESULTS Among 121 pediatric liver transplant patients, 65 (53.7%) were males; the median age at the time of liver transplantation was 43 (3-215) months. Fifteen patients (12.4%) had biliary strictures following transplantation. One (7%) patient with biliary stricture was treated via endoscopic retrograde cholangiopancreatography, and 12 patients (80%) underwent interventions via a percutaneous transhepatic approach. Nine of the 12 patients were treated successfully, requiring one or multiple procedures, while the remaining had surgery or laser therapy. Risk factors for the development of biliary strictures were biliary leak, acute cellular rejection, and the presence of two biliary anastomoses. CONCLUSIONS In our cohort, the presence of two biliary anastomoses and post-transplant complications including acute cellular rejection and early biliary leaks were associated with biliary strictures in pediatric liver transplantation recipients. Percutaneous transhepatic interventions result in good outcomes in most patients.
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Affiliation(s)
- Odelia Vingrovich
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Shiri Cooper
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Michael Gurevich
- Liver Transplant Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Aenov Cohen
- Invasive Radiology Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Yael Mozer-Glassberg
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Michal Rosenfeld Bar-Lev
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orith Waisbourd-Zinman
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Dammann E, Ording-Müller LS, Franchi-Abella S, Verhagen MV, McGuirk SP, Bokkers RPH, Clapuyt PRM, Deganello A, Tandoi F, de Ville de Goyet J, Hebelka H, de Lange C, Lozach C, Marra P, Mirza D, Kaliciński P, Patsch JM, Perucca G, Tsiflikas I, Renz DM, Schweiger B, Spada M, Toso S, Viremouneix L, Woodley H, Fischer L, Brinkert F, Petit P, Herrmann J. European Society of Pediatric Radiology survey of perioperative imaging in pediatric liver transplantation: (3) postoperative imaging. Pediatr Radiol 2024; 54:276-284. [PMID: 38285190 PMCID: PMC10830633 DOI: 10.1007/s00247-023-05842-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Liver transplantation is the state-of-the-art curative treatment for end-stage liver disease. Imaging is a key element in the detection of postoperative complications. So far, limited data is available regarding the best radiologic approach to monitor children after liver transplantation. OBJECTIVE To harmonize the imaging of pediatric liver transplantation, the European Society of Pediatric Radiology Abdominal Taskforce initiated a survey addressing the current status of imaging including the pre-, intra-, and postoperative phases. This paper reports the responses related to postoperative imaging. MATERIALS AND METHODS An online survey, initiated in 2021, asked European centers performing pediatric liver transplantation 48 questions about their imaging approach. In total, 26 centers were contacted, and 22 institutions from 11 countries returned the survey. RESULTS All sites commence ultrasound (US) monitoring within 24 h after liver transplantation. Monitoring frequency varies across sites, ranging from every 8 h to 72 h in early, and from daily to sporadic use in late postoperative phases. Predefined US protocols are used by 73% of sites. This commonly includes gray scale, color Doppler, and quantitative flow assessment. Alternative flow imaging techniques, contrast-enhanced US, and elastography are applied at 31.8%, 18.2%, and 63.6% of sites, respectively. Computed tomography is performed at 86.4% of sites when clarification is needed. Magnetic resonance imaging is used for selected cases at 36.4% of sites, mainly for assessment of biliary abnormalities or when blood tests are abnormal. CONCLUSION Diagnostic imaging is extensively used for postoperative surveillance of children after liver transplantation. While US is generally prioritized, substantial differences were noted in US protocol, timing, and monitoring frequency. The study highlights potential areas for future optimization and standardization of imaging, essential for conducting multicenter studies.
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Affiliation(s)
- Elena Dammann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lil-Sofie Ording-Müller
- Department of Pediatric Radiology, Rikshospitalet University Hospital: Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | | | - Martijn V Verhagen
- Department of Radiology, University Medical Centre Groningen: Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | - Simon P McGuirk
- Department of Radiology, Birmingham Children's Hospital, Birmingham, UK
| | - Reinoud P H Bokkers
- Department of Radiology, University Medical Centre Groningen: Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | | | | | - Francesco Tandoi
- Department of Hepatobiliary and Transplant Surgery, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Hanna Hebelka
- Department of Radiology, The Institute of Clinical Sciences, Gothenburg, Sweden
| | - Charlotte de Lange
- Department of Radiology, The Institute of Clinical Sciences, Gothenburg, Sweden
- Department of Pediatric Radiology, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Cecile Lozach
- Department of Radiology, Hôpital Universitaire Necker-Enfants-Malades, Paris, France
| | - Paolo Marra
- Department of Radiology, Azienda Ospedaliera Ospedali Riuniti di Bergamo: Aziende Socio Sanitarie Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Darius Mirza
- Department of Hepatobiliary and Transplant Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Piotr Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Janina M Patsch
- Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Giulia Perucca
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
- Department of Pediatric Radiology, Regina Margherita Children's Hospital, Turin, Italy
| | - Ilias Tsiflikas
- Department of Radiology, University Clinic of Tübingen, Tübingen, Germany
| | - Diane M Renz
- Department of Pediatric Radiology, Hannover Medical School: Medizinische Hochschule Hannover, Hannover, Germany
| | - Bernd Schweiger
- Department of Radiology, Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Clinic of Essen, Essen, Germany
| | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Seema Toso
- Department of Pediatric Radiology, Geneva University Hospitals: Hopitaux Universitaires Geneve, Geneva, Switzerland
| | - Loïc Viremouneix
- Department of Radiology, Hôpital Femme Mère Enfant - Hospices Civils de Lyon, Bron, France
| | - Helen Woodley
- Department of Pediatric Radiology, Leeds Children's Hospital, Leeds, UK
| | - Lutz Fischer
- Department of Visceral Transplant Surgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Brinkert
- Department of Pediatric Gastroenterology and Hepatology, Universitätsklinikum Hamburg- Eppendorf, Hamburg, Germany
| | - Philippe Petit
- Department of Pediatric Radiology, Aix Marseille University, Hôpital Timone Enfants, Marseille, France
| | - Jochen Herrmann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Sharma P, Shah R, Zavaletta V, Bertino F, Sankhla T, Kim JM, Leshen M, Shah J. Pediatric Transplant Interventions. Tech Vasc Interv Radiol 2023; 26:100930. [PMID: 38123288 DOI: 10.1016/j.tvir.2023.100930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The field of pediatric organ transplantation has grown significantly in recent decades, with interventional radiology (IR) playing an essential role in managing pre and post-transplant complications. Pediatric transplant patients face unique challenges compared to adults, including donor-recipient size mismatch, and complications of a growing child with changing physiology. Interventional radiologists play a major role in pediatric renal and liver transplant. IR interventions begin early in the child's pretransplant journey, with diagnostic procedures such as biopsies, angiograms, and cholangiograms. These procedures are essential for understanding the etiology of organ failure and identifying potential transplant candidates. Minimally invasive therapeutic procedures may serve as bridges to transplant and may include vascular access optimization for hemodialysis, transjugular intrahepatic portosystemic shunts (TIPS) creation, and tumor embolization or ablation. After transplant, image-guided biopsies for the surveillance of graft rejection and treatment of vascular or luminal stenoses, pseudoaneurysms, and anastomotic leaks can maintain the function and longevity of the transplant organ. Careful consideration must be given to patient size and evolving anatomy, radiation exposure, and the need for deeper sedation for pediatric patients. Despite these challenges, the integration of IR in pediatric transplant care has proven beneficial, offering minimally invasive alternatives to surgery, faster recovery times, and improved outcomes.
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Affiliation(s)
- Pareena Sharma
- Medical College of Georgia, Augusta University, Augusta, GA
| | - Ritu Shah
- Seth G.S Medical College and K.E.M Hospital, Mumbai, Maharashtra, India
| | - Vaz Zavaletta
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Frederic Bertino
- Department of Radiology, Interventional Radiology Section, NYU Langone Health/NYU Grossman School of Medicine, New York, NY
| | - Tina Sankhla
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jun Man Kim
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael Leshen
- Department of Radiology, Division of Interventional Radiology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Jay Shah
- Department of Radiology, Division of Interventional Radiology, Children's Healthcare of Atlanta, Atlanta, GA; Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, GA.
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Boillot O, Guillaud O, Wischlen E, Ruiz M, Boucaud C, Rohmer B, Lachaux A, Rivet C, Laverdure N, Dumortier J. Determinants of early surgical complications after pediatric liver transplantation: A single center/single surgeon experience over 20 years. Clin Res Hepatol Gastroenterol 2023; 47:102222. [PMID: 37783384 DOI: 10.1016/j.clinre.2023.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The risk of early surgical complications of liver transplantation (LT) is higher in children when compared with adults. The aims of the present retrospective study from a single center cohort/single surgeon were to identify the predictive factors for surgical complications after pediatric LT. METHODS All children receiving a first LT from October 1990 to October 2010 in our center were included. RESULTS Included 151 children (boys 55.0%), with a mean age of 4.8 ± 4.8 years, and a mean weight of 17.9 ± 14.4 kg. Thirty-seven patients were transplanted within the first year, and 59 patients had a body weight below 10 kg. The main initial liver disease was biliary atresia (49.0%). Living donor LT was performed in 39 cases (25.8%), cadaveric whole liver LT in 50 cases (33.1%), and cadaveric partial liver LT in 62 cases (41.1%). Early surgical complications included reoperation (37.8%), vascular complications (8.6%), i.e. arterial (3.3%) or portal thrombosis/stenosis (7.3%) within the first month, and biliary complications in the first 90 days occurred in 22.5% of the cases. The main indications for surgical revision were abdominal bleeding, treatment of a biliary complication, and bowel perforation. Multivariate analysis disclosed that only graft type (split and moreover from a living donor) was significantly and independently associated with the occurrence of biliary complication, and that indication for LT, period, graft type, and operative time were significantly and independently associated with the necessity of surgical revision. CONCLUSION Our results emphasize that surgical complications are frequent and strongly depend on patient/graft characteristics.
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Affiliation(s)
- Olivier Boillot
- Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, France; University Claude Bernard Lyon 1, France
| | - Olivier Guillaud
- Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, France; Ramsay Générale de Santé, Clinique de la Sauvegarde, France
| | - Emma Wischlen
- Department of Pediatric Hepatogastroenterology and Nutrition, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, France
| | - Mathias Ruiz
- Department of Pediatric Hepatogastroenterology and Nutrition, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, France
| | - Catherine Boucaud
- Department of Anesthesiology, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Lyon, France
| | - Barbara Rohmer
- Department of Pediatric Hepatogastroenterology and Nutrition, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, France
| | - Alain Lachaux
- University Claude Bernard Lyon 1, France; Department of Pediatric Hepatogastroenterology and Nutrition, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, France
| | - Christine Rivet
- Department of Pediatric Hepatogastroenterology and Nutrition, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, France
| | - Noémie Laverdure
- Department of Pediatric Hepatogastroenterology and Nutrition, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, France
| | - Jérôme Dumortier
- Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, France; University Claude Bernard Lyon 1, France.
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Doppler M, Fürnstahl C, Hammer S, Melter M, Verloh N, Schlitt HJ, Uller W. Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage-A Case Series. Tomography 2023; 9:1965-1975. [PMID: 37888745 PMCID: PMC10610565 DOI: 10.3390/tomography9050153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
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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Affiliation(s)
- Michael Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christin Fürnstahl
- Department of Radiology, University of Regensburg, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Simone Hammer
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Radiology, University of Regensburg, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Michael Melter
- University Children’s Hospital Regensburg, University of Regensburg, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Hans Jürgen Schlitt
- Department of Surgery, University of Regensburg, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Othman MY, Teh KH, Zahari Z. Biliary complications post liver resection for pediatric liver tumors. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000589. [PMID: 37441088 PMCID: PMC10335567 DOI: 10.1136/wjps-2023-000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Objective To review biliary complications following liver resection for liver tumors in children and their associated risk factors. Methods Retrospectively, we reviewed children who underwent liver resection for liver tumors from 2010 to 2019. Demographic data, operative details, types of complications, interventions and outcomes were studied. Results Eighty-six out of 108 liver resections were included in this study. The median age of patients was 1.8 years old, and 55% were male. The majority (95%) were malignant tumors, of which 87% were hepatoblastoma (n=71). The most common procedure performed was extended right hepatectomy (37%, n=32). Twelve (14%) patients had primary biliary complications: nine bile leakages and three biliary obstructions. Six cases of bile leakage were treated non-operatively with drainage only; however, one developed bilothorax. Three bile leakages underwent early operative intervention. Four patients underwent biliary reconstruction. Biliary complications were not significantly associated with age, sex, ethnicity or pathology of the tumor. Ten of them (83%) developed following extended hepatectomies (five right, five left), in which the left side had a higher rate of complications (63% vs 16%). None of the central hepatectomies had biliary complications. Biliary complication rates were significantly higher among those who had segmentectomy 1 (p=0.023). Conclusions Biliary complication is a significant morbidity following liver resection in children. Surgery is eventually required for complicated bile leakage and primary biliary strictures. Follow-up is mandatory since secondary biliary complications may occur after the initial resolution of bile leakage. The groups at high risk of developing biliary complications are extended left hepatectomies and segmentectomy 1.
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Affiliation(s)
- Mohd Yusran Othman
- Department of Paediatric Surgery, Hospital Tunku Azizah (Kuala Lumpur Women's and Children's Hospital, Ministry of Health Malaysia), Kuala Lumpur, Malaysia
| | - Kok Hoi Teh
- Department of Paediatrics, Hospital Tunku Azizah (Kuala Lumpur Women's and Children's Hospital, Ministry of Health Malaysia), Kuala Lumpur, Malaysia
| | - Zakaria Zahari
- Department of Paediatric Surgery, Hospital Tunku Azizah (Kuala Lumpur Women's and Children's Hospital, Ministry of Health Malaysia), Kuala Lumpur, Malaysia
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Rahayatri TH, Soeratman AR, Muhammad Amin RB, Margiadi DB, Tamba RP, Kasahara M. Early relaparotomy following pediatric living-donor liver transplantation: experience in an Indonesian national referral hospital. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000511. [PMID: 38328395 PMCID: PMC10848629 DOI: 10.1136/wjps-2022-000511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023] Open
Abstract
Background Living donor liver transplantation (LDLT) remains the only curative treatment for children with end-stage liver disease; however, complications of the procedure are associated with indications for early relaparotomy. Several risk factors associated with early relaparotomy after liver transplantation include pediatric end-stage liver disease (PELD) score, warm ischemia time (WIT), and cold ischemia time (CIT). Our study investigated the incidence and indications of early relaparotomy in postoperative pediatric LDLT recipients and compared the outcomes with patients who did not require relaparotomy. Methods A retrospective cohort study of pediatric LDLT recipients from Cipto Mangunkusumo Hospital, Jakarta, Indonesia, was collected from 2010 to August 2022. Indications for early relaparotomy were investigated. Factors analyzed in the early relaparotomy group compared with the nonrelaparotomy group included intraoperative blood loss, surgery duration, CIT, WIT, and PELD score. Results The highest indication for early relaparotomy was biliary leakage. Most patients who underwent early relaparotomy only had one incidence of relaparotomy (60%). The surgery duration in subjects with early relaparotomy was longer by a median of 3 hours compared with those without early relaparotomy (p=0.289). Intraoperative blood loss was greater in early relaparotomy subjects than in subjects without early relaparotomy (95 vs 77 mL/kg, p=0.552). Other factors, such as PELD score, CIT, and WIT, also showed no significant difference between the two groups. Conclusion Biliary leakage was the most common indication for early relaparotomy in our center. There were no preoperative or intraoperative factors that significantly influenced the incidence of early relaparotomy due to the limited sample size and the early advancement of our liver transplant center.
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Affiliation(s)
- Tri Hening Rahayatri
- Division of Pediatric Surgery, Department of Surgery, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, Indonesia
- Division of Pediatric Surgery, Department of Surgery, Universitas Indonesia Fakultas Kedokteran, Central Jakarta, Indonesia
| | - Alif Rizqy Soeratman
- Department of Surgery, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, Indonesia
| | | | | | - Riana Pauline Tamba
- Division of Pediatric Surgery, Department of Surgery, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, Indonesia
- Division of Pediatric Surgery, Department of Surgery, Universitas Indonesia Fakultas Kedokteran, Central Jakarta, Indonesia
| | - Mureo Kasahara
- Department of Transplantation, National Center for Child Health and Development, Setagaya-ku, Japan
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10
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Long-Term Outcome Following Liver Transplantation for Primary Hepatic Tumors-A Single Centre Observational Study over 40 Years. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020202. [PMID: 36832331 PMCID: PMC9954409 DOI: 10.3390/children10020202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
The incidence of pediatric liver tumors in general has been rising over the last years and so is the number of children undergoing liver transplantation for this indication. To contribute to the ongoing improvement of pre- and post-transplant care, we aim to describe outcome and risk factors in our patient cohort. We have compared characteristics and outcome for patients transplanted for hepatoblastoma to other liver malignancies in our center between 1983 and 2022 and analysed influential factors on tumor recurrence and mortality using nominal logistic regression analysis. Of 39 children (16 f) who had transplants for liver malignancy, 31 were diagnosed with hepatoblastoma. The proportion of malignant tumors in the transplant cohort rose from 1.9% (1983-1992) to 9.1% in the current decade (p < 0.0001). Hepatoblastoma patients were transplanted at a younger age and were more likely to have tumor extent beyond the liver. Post-transplant bile flow impairment requiring intervention was significantly higher compared to our total cohort (48 vs. 24%, p > 0.0001). Hearing loss was a common side effect of ototoxic chemotherapy in hepatoblastoma patients (48%). The most common maintenance immunosuppression were mTor-inhibitors. Risk factors for tumor recurrence in patients with hepatoblastoma were higher AFP before transplant (AFPpre-LTX), a low ratio of AFPmax to AFPpre-LTX and salvage transplantation. Liver malignancies represent a rising number of indications for liver transplantation in childhood. Primary tumor resection can spare a liver transplant with all its long-term complications, but in case of tumor recurrence, transplantation might have inferior outcome. The rate of acute biopsy-proven rejections and biliary complications in comparison to our total transplant cohort needs further investigations.
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11
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Feasibility and Safety of ERCP in the Treatment of Biliary Strictures after Liver Transplantation: With a Report of 37 Cases. Gastroenterol Res Pract 2022; 2022:4498443. [PMID: 36052377 PMCID: PMC9427298 DOI: 10.1155/2022/4498443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Liver transplantation (LT) is an effective treatment option for patients with end-stage liver disease; biliary complications are important cause of death in posttransplant patients. Endoscopic retrograde cholangiopancreatography (ERCP) has an irreplaceable role in the diagnosis and treatment of patients with biliary tract disease. Methods. The clinical data of patients with biliary strictures (BS) after LT treated with ERCP admitted to the Third Xiangya Hospital of Central South University from September 2016 to October 2021 were reviewed; the changes in temperature, bilirubin, and albumin before and after treatment and postoperative complications were analyzed. Results. A total of 41 patients were included in the study, and biliary stents were successfully placed in 37 cases (90.2%), while 4 cases (9.8%) were unsuccessful due to complete BS. Patients with ERCP guided biliary stenting had a significant improvement in bilirubin index compared to the preoperative period (
). 27 patients (73.0%) had complete relief of symptoms after 1 ERCP-guided treatment, and 10 patients (27.0%) developed BS again at different times after the first ERCP treatment, among which 8 patients developed BS again within 1 year after the first treatment and 2 patients developed BS again after 1 year after the first treatment. The incidence of endoscopy-related adverse events was 35.14%, with no serious adverse events. Conclusion. ERCP-guided biliary stenting was an effective and safety treatment for BS after LT.
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12
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Gutierrez-Villamil C, Velez-Gutierrez C, Arevalo-Leal S, Rivera-Baquero J, Marín-Oyaga V. Hepatobiliary Scintigraphy to Evaluate Biliary Complications of Pediatric Liver Transplantation: An Account of an Experience. Eur J Pediatr Surg 2022; 32:258-262. [PMID: 33378778 DOI: 10.1055/s-0040-1721772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Hepatobiliary scintigraphy (HS) is a noninvasive imaging technique whose use in the follow-up of liver transplantation has not been duly documented. The main objective of this study is to describe the experience of using this technique to detect biliary complications in pediatric patients following liver transplantation. MATERIALS AND METHODS A retrospective, observational, and descriptive study involving 86 pediatric patients who had undergone liver transplantation between 2013 and 2018. Of the 86, 31 had undergone at least one HS during their postoperative period. RESULTS A total of 45 studies were performed on 31 patients (36% of the patients undergoing transplantation during that time period). Patient ages ranged from 5 to 204 months (mean = 50 months). A total of 22 transplants (71%) were from living donors and 9 (29%) were from cadaveric donors. Of the 45 studies, 22 were positive for biliary complications, and all of them had an impact on clinical decision-making. The remaining 23 studies were negative. Of these 23, 19 continued under medical treatment and the other four underwent an additional intervention with positive surgical outcomes in all cases. All scintigraphy studies revealed hepatocellular dysfunction and cholestasis. CONCLUSION The HS is a useful, noninvasive, and diagnostic procedure for the early diagnosis of biliary complications that may impact the evolution of disease in liver transplant patients. It allows the treating physician to make a more informed decision regarding expectant management, surgical management, or a less invasive course of action for transplantation complications.
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Affiliation(s)
- Claudia Gutierrez-Villamil
- Nuclear Medicine Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogota, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Camila Velez-Gutierrez
- Nuclear Medicine Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogota, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Sinay Arevalo-Leal
- Nuclear Medicine Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogota, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Jairo Rivera-Baquero
- Surgery and Transplant Department, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia
| | - Víctor Marín-Oyaga
- Nuclear Medicine Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogota, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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13
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Dulcetta L, Marra P, Carbone FS, Bonaffini PA, Sallemi C, Sansotta N, Colledan M, D'Antiga L, Sironi S. Biliary complications in pediatric liver transplantation: findings of percutaneous transhepatic cholangiography in a large single-center cohort. Pediatr Radiol 2022; 52:1061-1074. [PMID: 35107594 DOI: 10.1007/s00247-021-05278-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although biliary complications after orthotopic liver transplantation represent a common source of morbidity and mortality, decreasing graft survival, consensus is lacking on their management in the pediatric population. OBJECTIVE The aim of this study was to present the prevalence of such biliary complications and their interventional radiologic management with representative images. MATERIALS AND METHODS This retrospective study reports our experience with percutaneous transhepatic cholangiography in the management of biliary complications after orthotopic liver transplantation in pediatric patients. This study enrolled all pediatric patients (<18 years old) who underwent percutaneous transhepatic cholangiography for the management of biliary complications after orthotopic liver transplantation at a tertiary care center between January 2010 and December 2020. Diagnosis of biliary complications and indication to perform percutaneous transhepatic cholangiography were based on clinical, laboratory or radiologic data. RESULTS Among the 301 orthotopic liver transplantations, 78 (26%) developed biliary complications that were managed by interventional radiology: these included 52 (17.3%) biliary strictures, 19 (6.3%) bile leaks, 5 (1.7%) biliary stones, 1 (0.3%) iatrogenic biliary obstruction and 1 (0.3%) vanishing syndrome. The median time interval between orthotopic liver transplantation and the diagnosis of biliary complications was 6.0 years (interquartile range [IQR] 8.2 years). Percutaneous transhepatic cholangiography and biliary duct catheterization were successful in all cases, with low rates of complications that were variable among subgroups. CONCLUSION A wide spectrum of biliary complications can occur after pediatric orthotopic liver transplantation. In this large single-center experience, we highlight the value of percutaneous transhepatic cholangiography in their diagnosis and management. Percutaneous treatments in pediatric patients are safe and effective, providing resolution or serving as a bridge to surgery, including re-transplantation.
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Affiliation(s)
- Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy. .,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Claudio Sallemi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Naire Sansotta
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Michele Colledan
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo D'Antiga
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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14
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Evaluation and management of biliary complications after pediatric liver transplantation: pearls and pitfalls for percutaneous techniques. Pediatr Radiol 2022; 52:570-586. [PMID: 34713322 DOI: 10.1007/s00247-021-05212-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/16/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
In pediatric liver transplantation, bile duct complications occur with a greater incidence than vascular anastomotic dysfunction and represent a major source of morbidity and mortality. While surgical re-anastomosis can reduce the need for retransplantation, interventional radiology offers minimally invasive and graft-saving therapies. The combination of small patient size and prevailing Roux-en-Y biliary enteric anastomotic techniques makes endoscopic retrograde cholangiopancreatography difficult if not impossible. Expertise in percutaneous management is therefore imperative. This article describes post-surgical anatomy, pathophysiology and noninvasive imaging of biliary complications. We review percutaneous techniques, focusing heavily on biliary access and interventions for reduced liver grafts. Subsequently we review the results and adverse events of these procedures and describe conditions that masquerade as biliary obstruction.
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15
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Percutaneous Balloon Dilatation for Hepaticojejunostomy Stricture Following Paediatric Liver Transplantation: Long-Term Results of an Institutional "Three-Session" Protocol. Cardiovasc Intervent Radiol 2021; 45:330-336. [PMID: 34796374 DOI: 10.1007/s00270-021-03000-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/26/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE The aim of this study was to report the long-term results of an institutional protocol of percutaneous biliary balloon dilatation (PBBD) on paediatric patients with benign anastomotic stricture after liver transplantation. As a secondary objective, we evaluated risk factors associated with post-treatment re-stricture. MATERIALS AND METHODS Fourteen paediatric, post-liver transplant patients with benign anastomotic stricture of Roux-en-Y hepaticojejunostomy were included. All patients underwent the same treatment protocol of three PBBD procedures with 15-day intervals. Clinical outcome was analysed using the Terblanche classification. Primary patency rate was assessed with the Kaplan-Meier test. RESULTS All patients had an initial successful result (Terblanche grade, excellent/good) after PBBD. At the end of the follow-up time of 35.7 ± 21.1 months (CI95%, 23.5-47.9), 10 patients persisted with excellent/good grading, while the remaining 4 had re-stricture, all of the latter occurring within the first 19 months. Patency rate after percutaneous treatment at 1, 3, and 5 years were 85.7%, 70%, and 70%, respectively. History of major complication after liver transplantation was associated with 5 times higher risk of re-stricture, HR 5.48 [95% CI, 2.18-8.78], p = 0.018. CONCLUSION In paediatric patients with benign anastomotic stricture of hepaticojejunostomy after liver transplantation, the "Three-session" percutaneous biliary balloon dilatation protocol is associated with a high rate of long-term success. In this limited series, the history of post-liver transplant major complication, defined as complications requiring a reintervention under general anaesthesia or advanced life support, seems to be an independent risk factor for stricture recurrence.
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16
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Watson TA, Barber J, Woodley H. Paediatric gastrointestinal and hepatobiliary radiology: why do we need subspecialists, and what is new? Pediatr Radiol 2021; 51:554-569. [PMID: 33743039 DOI: 10.1007/s00247-020-04778-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/06/2020] [Accepted: 07/08/2020] [Indexed: 12/17/2022]
Abstract
We present the case for subspecialisation in paediatric gastrointestinal and hepato-pancreatico-biliary radiology. We frame the discussion around a number of questions: What is different about the paediatric patient and paediatric gastrointestinal system? What does the radiologist need to do differently? And finally, what can be translated from these subspecialty areas into everyday practice? We cover conditions that the sub-specialist might encounter, focusing on entities such as inflammatory bowel disease and hepatic vascular anomalies. We also highlight novel imaging techniques that are a focus of research in the subspecialties, including contrast-enhanced ultrasound, MRI motility, magnetisation transfer factor, and magnetic resonance elastography.
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Affiliation(s)
- Tom A Watson
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Joy Barber
- Department of Radiology, St. George's Hospital NHS Foundation Trust, London, UK
| | - Helen Woodley
- Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
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17
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Kilic M, Karaca CA, Yilmaz C, Farajov R, Iakobadze Z, Kilic K, Aydogdu S. Bilioenteric Reconstruction Techniques in Pediatric Living Donor Liver Transplantation. Liver Transpl 2021; 27:257-263. [PMID: 37160015 DOI: 10.1002/lt.25845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/16/2020] [Accepted: 07/01/2020] [Indexed: 01/13/2023]
Abstract
Biliary complications (BCs) are still a major cause of morbidity following liver transplantation despite the advancements in the surgical technique. Although Roux-en-Y (RY) hepaticojejunostomy has been the standard technique for years in pediatric patients, there is a limited number of reports on the feasibility of duct-to-duct (DD) anastomosis, and those reports have controversial outcomes. With the largest number of patients ever reported on the topic, this study aims to discuss the feasibility of the DD biliary reconstruction technique in pediatric living donor liver transplantation (LDLT). After the exclusion of the patients with biliary atresia, patients who received either deceased donor or right lobe grafts, and retransplantation patients, data from 154 pediatric LDLTs were retrospectively analyzed. Patients were grouped according to the applied biliary reconstruction technique, and the groups were compared using BCs as the outcome. The overall BC rate was 13% (n = 20), and the groups showed no significant difference (P = 0.6). Stricture was more frequent in the DD reconstruction group; however, this was not statistically significant (P = 0.6). The rate of bile leak was also similar in both groups (P = 0.6). The results show that the DD reconstruction technique can achieve similar outcomes when compared with RY anastomosis. Because DD reconstruction is a more physiological way of establishing bilioenteric integrity, it can safely be applied.
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Affiliation(s)
- Murat Kilic
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Can A Karaca
- Faculty of Medicine, Izmir University of Economics, Izmir, Turkey
| | - Cahit Yilmaz
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Rasim Farajov
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Zaza Iakobadze
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Kamil Kilic
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Sema Aydogdu
- Department of Pediatric Gastroenterology, Ege University Faculty of Medicine, Izmir, Turkey
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18
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Endoscopic treatment of biliary complications after duct-to-duct biliary anastomosis in pediatric liver transplantation. Langenbecks Arch Surg 2019; 404:875-883. [DOI: 10.1007/s00423-019-01804-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 07/04/2019] [Indexed: 02/07/2023]
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19
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Czubkowski P, Markiewicz-Kijewska M, Janiszewski K, Rurarz M, Kaliciński P, Jarzębicka D, Pertkiewicz J, Kamińska D, Jankowska I, Teisseyre M, Szymczak M, Pawłowska J. Percutaneous Treatment of Biliary Strictures After Pediatric Liver Transplantation. Ann Transplant 2018; 23:845-851. [PMID: 30531688 PMCID: PMC6299781 DOI: 10.12659/aot.910528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Biliary strictures (BS) are frequent after pediatric liver transplantation (LTx) and in spite of ongoing progress, they remain a significant cause of morbidity. In children, the majority of reconstruction is hepatico-jejunal anastomosis (HJA). The aim of this study was to analyze our experience in percutaneous transhepatic treatment of BS. Material/Methods Between 1998 and 2014, 589 (269 living donor) pediatric LTx were performed in our institution. We retrospectively reviewed clinical data of patients with HJA who developed BS and who underwent percutaneous transhepatic biliary drainage (PTBD). Results Out of 400 patients with HJA, 35 patients developed BS. There were 27 cases (77%) of anastomotic BS (ABS) and 8 cases (23%) of multilevel BS (MBS). Ninety-two PTBD sessions (2.5 per patient) were performed, with successful outcomes in 20 cases (57%). Fifteen patients, after failed PTBD, underwent surgery which was successful in 11 cases. Overall good outcomes were achieved in 31 cases (88.5%). The most common complication of PTBD was cholangitis which occurred in 5.4% of the cases. We did not find any risk factors for PTBD failure, except for treatment occurring before 2007. Conclusions Percutaneous treatment is effective and safe in BS and is recommended as a first-line approach. The majority of patients in our study required multiple interventions, however, the overall risk of complications was low. Surgery is essential in selected cases and always should be considered if PTBD fails.
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Affiliation(s)
- Piotr Czubkowski
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | | | | | - Małgorzata Rurarz
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Kaliciński
- Department of Pediatric Surgery and Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Dorota Jarzębicka
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Jan Pertkiewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Diana Kamińska
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Irena Jankowska
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Mikołaj Teisseyre
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Marek Szymczak
- Department of Pediatric Surgery and Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Joanna Pawłowska
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
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20
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Horvat N, Marcelino ASZ, Horvat JV, Yamanari TR, Batista Araújo-Filho JDA, Panizza P, Seda-Neto J, Antunes da Fonseca E, Carnevale FC, Mendes de Oliveira Cerri L, Chapchap P, Cerri GG. Pediatric Liver Transplant: Techniques and Complications. Radiographics 2018; 37:1612-1631. [PMID: 29019744 DOI: 10.1148/rg.2017170022] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Liver transplant is considered to be the last-resort treatment approach for pediatric patients with end-stage liver disease. Despite the remarkable advance in survival rates, liver transplant remains an intricate surgery with significant morbidity and mortality. Early diagnosis of complications is crucial for patient survival but is challenging given the lack of specificity in clinical presentation. Knowledge of the liver and vascular anatomy of the donor and the recipient or recipients before surgery is also important to avoid complications. In this framework, radiologists play a pivotal role on the multidisciplinary team in both pre- and postoperative scenarios by providing a road map to guide the surgery and by assisting in diagnosis of complications. The most common complications after liver transplant are (a) vascular, including the hepatic artery, portal vein, hepatic veins, and inferior vena cava; (b) biliary; (c) parenchymal; (d) perihepatic; and (e) neoplastic. The authors review surgical techniques, the role of each imaging modality, normal posttransplant imaging features, types of complications after liver transplant, and information required in the radiology report that is critical to patient care. They present an algorithm for an imaging approach for pediatric patients after liver transplant and describe key points that should be included in radiologic reports in the pre- and postoperative settings. Online supplemental material is available for this article. ©RSNA, 2017.
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Affiliation(s)
- Natally Horvat
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Antonio Sergio Zafred Marcelino
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Joao Vicente Horvat
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Tássia Regina Yamanari
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Jose de Arimateia Batista Araújo-Filho
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Pedro Panizza
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Joao Seda-Neto
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Eduardo Antunes da Fonseca
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Francisco Cesar Carnevale
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Luciana Mendes de Oliveira Cerri
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Paulo Chapchap
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Giovanni Guido Cerri
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
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Alobaidi R, Anton N, Cave D, Moez EK, Joffe AR. Predicting early outcomes of liver transplantation in young children: The EARLY study. World J Hepatol 2018; 10:62-72. [PMID: 29399279 PMCID: PMC5787685 DOI: 10.4254/wjh.v10.i1.62] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine potentially modifiable predictors of early outcomes after liver transplantation in children of age < 3 years.
METHODS This study was a retrospective chart review including all consecutive children of age less than 3-years-old having had a liver transplant done at the Western Canadian referral center from June 2005 to June 2015. Pre-specified potential predictor variables and primary and secondary outcomes were recorded using standard definitions and a case report form. Associations between potential predictor variables and outcomes were determined using univariate and multiple logistic [odds ratio (OR); 95%CI] or linear (effect size, ES; 95%CI) regressions.
RESULTS There were 65 children, of mean age 11.9 (SD 7.1) mo and weight 8.5 (2.1) kg, with biliary-atresia in 40 (62%), who had a living related donor [LRD; 29 (45%)], split/reduced [21 (32%)] or whole liver graft [15 (23%)]. Outcomes after liver transplant included: ventilator-days of 12.5 (14.1); pediatric intensive care unit mortality of 5 (8%); re-operation in 33 (51%), hepatic artery thrombosis (HAT) in 12 (19%), portal vein thrombosis (PVT) in 11 (17%), and any severe complication (HAT, PVT, bile leak, bowel perforation, intraabdominal infection, retransplant, or death) in 32 (49%) patients. Predictors of the prespecified primary outcomes on multiple regression were: (1) HAT: split/reduced (OR 0.06; 0.01, 0.76; P = 0.030) or LRD (OR 0.16; 0.03, 0.95; P = 0.044) vs whole liver graft; and (2) ventilator-days: surgeon (P < 0.05), lowest antithrombin (AT) postoperative day 2-5 (ES -0.24; -0.47, -0.02; P = 0.034), and split/reduced (ES -12.5; -21.8, -3.2; P = 0.009) vs whole-liver graft. Predictors of the pre-specified secondary outcomes on multiple regression were: (1) any thrombosis: LRD (OR 0.10; 0.01, 0.71; P = 0.021) or split/reduced (OR 0.10; 0.01, 0.85; P = 0.034) vs whole liver graft, and lowest AT postoperative day 2-5 (OR 0.93; 0.87, 0.99; P = 0.038); and (2) any severe complication: surgeon (P < 0.05), lowest AT postoperative day 2-5 (OR 0.92; 0.86-0.98; P = 0.016), and split/reduced (OR 0.06; 0.01, 0.78; P = 0.032) vs whole-liver graft.
CONCLUSION In young children, whole liver graft and surgeon was associated with more complications, and higher AT postoperative day 2-5 was associated with fewer complications early after liver transplantation.
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Affiliation(s)
- Rashid Alobaidi
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta and Stollery Children’s Hospital, Edmonton, Alberta T6G 1C9, Canada
| | - Natalie Anton
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta and Stollery Children’s Hospital, Edmonton, Alberta T6G 1C9, Canada
| | - Dominic Cave
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta and Stollery Children’s Hospital, Edmonton, Alberta T6G 1C9, Canada
| | - Elham Khodayari Moez
- School of Public Health, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
| | - Ari R Joffe
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta and Stollery Children’s Hospital, Edmonton, Alberta T6G 1C9, Canada
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Vicentine FPP, Gonzalez AM, Beninni BB, Azevedo RAD, Linhares MM, Goldenberg A, Lopes GDJ, Martins JL, Salzedas AA. Use of fibrinogen and thrombin sponge in pediatric split liver transplantation. Acta Cir Bras 2017; 32:673-679. [PMID: 28902943 DOI: 10.1590/s0102-865020170080000009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/18/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose: To analyze the use of this sponge in pediatric patients undergoing split-liver transplantation. Methods: Retrospective study, including 35 pediatric patients undergoing split-liver transplantation, divided into two groups according to the use of the sponge: 18 patients in Group A (no sponge) and 17 in Group B (with sponge). Results: The characteristics of recipients and donors were similar. We observed greater number of reoperation due to bleeding in the wound area in Group A (10 patients - 55.5%) than in Group B (3 patients - 17.6%); p = 0.035. The median volume of red blood cells transfused in Group A was significantly higher (73.4 ± 102.38 mL/kg) than that in Group B (35.1 ± 41.67 mL/kg); p = 0.048. Regarding bile leak there was no statistical difference. Conclusion: The use of the human fibrinogen and thrombin sponge, required lower volume of red blood cell transfusion and presented lower reoperation rates due to bleeding in the wound area.
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Affiliation(s)
- Fernando Pompeu Piza Vicentine
- Fellow PhD degree, Postgraduate Program in Interdisciplinary Surgical Sciences, Universidade Federal de São Paulo (UNIFESP), Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; statistics analysis; final approval of the version to be published
| | - Adriano Miziara Gonzalez
- PhD, Associate Professor, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; drafting the article; technical procedures, final approval of the version to be published
| | - Barbara Burza Beninni
- Associate Professor, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Intellectual content of the study; acquisition, analysis and interpretation of data
| | - Ramiro Anthero de Azevedo
- PhD, Associate Professor, Division of Pediatric Surgery, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study, analysis and interpretation of data, final approval of the version to be published
| | - Marcelo Moura Linhares
- PhD, Associate Professor, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; drafting the article; technical procedures, final approval of the version to be published
| | - Alberto Goldenberg
- PhD, Chairman, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Intellectual content of the study, final approval of the version to be published
| | - Gaspar de Jesus Lopes
- PhD, Chairman, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Intellectual content of the study, final approval of the version to be published
| | - Jose Luiz Martins
- PhD, Associate Professor, Division of Pediatric Surgery, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study, analysis and interpretation of data, final approval of the version to be published
| | - Alcides Augusto Salzedas
- PhD, Associate Professor, Division of Pediatric Surgery, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study, analysis and interpretation of data, final approval of the version to be published
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Total Pancreatectomy With Islet Autotransplantation Resolves Pain in Young Children With Severe Chronic Pancreatitis. J Pediatr Gastroenterol Nutr 2017; 64:440-445. [PMID: 28231072 PMCID: PMC5327823 DOI: 10.1097/mpg.0000000000001314] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Fear of diabetes and major surgery may prohibit referral of young children severely affected by pancreatitis for total pancreatectomy with islet autotransplant (TPIAT). We evaluated outcomes in our youngest TPIAT recipients, 3 to 8 years of age at surgery. METHODS Medical records were reviewed for 17 children (9 girls) ages 8 years or younger undergoing TPIAT from 2000 to 2014. Most (14/17) had genetic risk factors for pancreatitis. Since 2006, TPIAT recipients were followed prospectively with health questionnaires including assessments of pain and narcotic use, and scheduled hemoglobin A1c (HbA1c) and mixed-meal tolerance tests (6 mL/kg Boost HP) before surgery, and at regular intervals after. Patients are 1 to 11 years post-TPIAT (median 2.2 years). Data are reported as median (25th, 75th percentile). RESULTS All had relief of pain, with all 17 patients off narcotics at most recent follow-up. Hospitalization rates decreased from 5.0 hospitalization episodes per person-year of follow-up before TPIAT, to 0.35 episodes per person-year of follow-up after TPIAT. Fourteen (82%) discontinued insulin, higher than the observed insulin independence rate of 41% in 399 patients older than 8 years of age undergoing TPIAT over the same interval (P = 0.004). Median post-TPIAT HbA1c was 5.9% (5.6%, 6.3%), and within patient post-TPIAT mean HbA1c was ≤6.5% for all but 2 patients. CONCLUSIONS Young children with severe refractory chronic pancreatitis may be good candidates for TPIAT, with high rates of pain relief and insulin independence, and excellent glycemic control in the majority.
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Vicentine FPP, Gonzalez AM, Azevedo RAD, Benini BB, Linhares MM, Lopes-Filho GDJ, Martins JL, Salzedas-Netto AA. PEDIATRIC LIVER TRANSPLANTATION WITH EX-SITU LIVER TRANSECTION AND THE APPLICATION OF THE HUMAN FIBRINOGEN AND THROMBIN SPONGE IN THE WOUND AREA. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2016; 29:236-239. [PMID: 28076477 PMCID: PMC5225862 DOI: 10.1590/0102-6720201600040006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/30/2016] [Indexed: 01/13/2023]
Abstract
Background Surgical strategy to increase the number of liver transplants in the pediatric population is the ex-situ liver transection (reduction or split). However, it is associated with complications such as hemorrhage and leaks. The human fibrinogen and thrombin sponge is useful for improving hemostasis in liver surgery. Aim Compare pediatric liver transplants with ex-situ liver transection (reduction or split) with or without the human fibrinogen and thrombin sponge. Methods Was performed a prospective analysis of 21 patients submitted to liver transplantation with ex-situ liver transection with the application of the human fibrinogen and thrombin sponge in the wound area (group A) and retrospective analysis of 59 patients without the sponge (group B). Results The characteristics of recipients and donors were similar. There were fewer reoperations due to bleeding in the wound area in group A (14.2%) compared to group B (41.7%, p=0.029). There was no difference in relation to the biliary leak (group A: 17.6%, group B: 5.1%, p=0.14). Conclusion There was a lower number of reoperations due to bleeding of the wound area of the hepatic graft when the human fibrinogen and thrombin sponge were used.
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Affiliation(s)
- Fernando Pompeu Piza Vicentine
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Adriano Miziara Gonzalez
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | | | - Barbara Burza Benini
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Marcelo Moura Linhares
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Gaspar de Jesus Lopes-Filho
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Jose Luiz Martins
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Alcides Augusto Salzedas-Netto
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
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25
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Shakhin V, Iyer K, Chu J, Ramaswami A, Lester N, Arnon R. Roux-en-Y intussusception after pediatric liver transplant - A case report. Pediatr Transplant 2016; 20:855-8. [PMID: 27345958 DOI: 10.1111/petr.12743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/29/2022]
Abstract
Small bowel obstruction in a pediatric patient following liver transplant often results from adhesions, hernias, or post-transplant lymphoproliferative disease. Here, we present an unusual and previously unreported entity - Roux-en-Y intussusception in an eight-yr-old female several years after liver transplantation. Although a rare complication, Roux-en-Y intussusception should be considered as a potential etiology in the patient presenting with bowel obstruction, with specific attention to acute presentation accompanying jaundice.
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Affiliation(s)
- Victoria Shakhin
- Department of Pediatrics, Mount Sinai Medical Center, New York, NY, USA
| | - Kishore Iyer
- Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY, USA
| | - Jaime Chu
- Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY, USA.,Department of Pediatric Gastroenterology, Mount Sinai Medical Center, New York, NY, USA
| | - Archana Ramaswami
- Department of Pediatric Gastroenterology, Mount Sinai Medical Center, New York, NY, USA
| | - Neil Lester
- Department of Radiology, Mount Sinai Medical Center, New York, NY, USA
| | - Ronen Arnon
- Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY, USA.,Department of Pediatric Gastroenterology, Mount Sinai Medical Center, New York, NY, USA
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40 Jahre Lebertransplantation im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0085-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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