Biliary complications and percutaneous radiological interventions in pediatric transplant patients under 36 months of age

Purpose: Liver Transplantation is an important treatment option in chronic and severe acute liver failure, but it may cause many complications. Percutaneous radiological interventions are important and effective method in the diagnosis and treatment of biliary complications. In our study, we aimed to demonstrate the importance and effectiveness of biliary complications developing in patients under 36 months of liver transplantation and percutaneous radiological interventions in the management of these complications. Materials and Methods: Between January 2007-October 2019, 191 liver transplantations were performed in 186 patients under 36 months of age in our center. 39 patients were excluded for various reasons. Demographic data, surgical procedures and biliary interventions were analyzed retrospectively in 152 liver transplantation procedures at 147 patients. Results: Biliary complications developed in 38 (25%) of 152 liver transplantations (stenosis 25, leakage 9, both stenosis-leakage 4). PTC/PTBD was performed in 34 (89.5%) of 38 patients. 4 patients operated (10.5%) for leakage. Except these 34 patients, 5 patients underwent PTC due to elevated liver enzymes and bilirubin; biliary pathology wasn't detected. In statistical analysis, significant relationship was found between anastomosis (Duct-duct, hepaticojejunostomy) and biliary complicatioıns (p= 0.001). Patients who underwent PTC were followed with catheter for median 2.8 months (0.03-18.7), catheter-free for median 11.1 months (0-89). In 5 (21.7%) of 23 patients who underwent balloon dilatation, the stenosis relapsed after average of 5.4 months (3.5-7.5) and balloon dilatation was repeated. Patients with recurrence were followed up for an average of 8.5 months (1-22 months), and patients without recurrence were followed up for 30 months (0-107 months) without symptoms. Conclusion: Percutaneous biliary intervention are minimally invasive techniques with high success rates in the treatment of biliary complications after liver transplantation. The effectiveness of percutaneous biliary intervention is similar to surgical intervention in the treatment of biliary complications after pediatric liver transplantation.