Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.
Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.
Pediatr Transplant. 2024 Aug;28(5):e14814. doi: 10.1111/petr.14814.
There are no standard management protocols for the treatment of bile leak (BL) after liver transplantation. The objective of this study is to describe treatment options for BL after pediatric LT.
Retrospective analysis (January 2010-March 2023).
preoperative data, status at diagnosis, and postoperative outcome. Four groups: observation (n = 9), percutaneous transhepatic cholangiography (PTC, n = 38), ERCP (2), and surgery (n = 27).
Nine hundred and thirty-one pediatric liver transplantation (859 LDLT and 72 DDT); 78 (8.3%) patients had BL, all in LDLT. The median (IQR) peritoneal bilirubin (PB) level and fluid-to-serum bilirubin ratio (FSBR) at diagnosis was 14.40 mg/dL (8.5-29), and 10.7 (4.1-23.7). Patients who required surgery for treatment underwent the procedure earlier, at a median of 14 days (IQR: 7-19) versus 22 days for PTC (IQR: 15-27, p = 0.002). PB and FSBR were significantly lower in the observation group. In 11 cases, conservative management had resolution of the BL in an average time of 35 days, and 38 patients underwent PTC in a median time of 22 days (15-27). Twenty-seven (34.6%) patients were reoperated as initial treatment for BL in a median time of 17 days (1-108 days); 25 (33%) patients evolved with biliary stricture, 5 (18.5%) after surgery, and 20 (52.6%) after PTC (p = 0.01).
Patients with BL who were observed presented significantly lower levels of PB and FSBR versus those who underwent PTC or surgery. Patients treated with PTC presented higher rates of biliary stricture during the follow-up.
描述儿童肝移植（LT）后胆汁漏（BL）的治疗选择。
回顾性分析（2010 年 1 月至 2023 年 3 月）。
术前数据、诊断时的状态和术后结果。分为 4 组：观察组（n=9）、经皮肝穿刺胆道造影术（PTC，n=38）、内镜逆行胰胆管造影术（ERCP，n=2）和手术组（n=27）。
931 例儿童肝移植（859 例 LDLT 和 72 例 DDT）；78 例（8.3%）患者出现 BL，均为 LDLT。诊断时的中位（IQR）腹膜胆红素（PB）水平和胆汁液血清胆红素比值（FSBR）分别为 14.40mg/dL（8.5-29）和 10.7（4.1-23.7）。需要手术治疗的患者更早进行手术，中位时间为 14 天（IQR：7-19），而 PTC 的中位时间为 22 天（IQR：15-27，p=0.002）。观察组 PB 和 FSBR 明显较低。在 11 例病例中，保守治疗平均 35 天可缓解 BL，38 例患者 PTC 的中位时间为 22 天（15-27）。27 例（34.6%）患者作为 BL 的初始治疗进行再次手术，中位时间为 17 天（1-108 天）；25 例（33%）患者出现胆管狭窄，术后 5 例（18.5%），PTC 后 20 例（52.6%）（p=0.01）。
观察组患者的 PB 和 FSBR 明显低于行 PTC 或手术的患者。行 PTC 治疗的患者在随访期间出现胆管狭窄的发生率较高。
