Pape Thorben, Baumann Ulrich, Pfister Eva-Doreen, Vondran Florian W R, Richter Nicolas, Dingemann Jens, Hunkemöller Anna M, von Garrel Tabea, Wedemeyer Heiner, Schneider Andrea, Lenzen Henrike, Stahl Klaus
Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany.
Division of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
Pediatr Gastroenterol Hepatol Nutr. 2025 Mar;28(2):113-123. doi: 10.5223/pghn.2025.28.2.113. Epub 2025 Mar 5.
Cholestatic complications remain a primary cause of post-liver transplantation (LTX) morbidity in pediatric patients. Standard biliary access by endoscopic retrograde cholangioscopy may not be feasible due to modified biliary drainage. Percutaneous transhepatic biliary drainage (PTCD) may be performed alternatively. However, systematic data concerning safety and efficacy of PTCD in these patients are scarce.
In this retrospective study, procedural and safety characteristics of PTCD in pediatric patients following LTX were analyzed. We compared laboratory indicators of inflammation, cholestasis, and graft function before and at 6 and 12 months after the first PTCD insertion. Efficacy was analyzed by percentage of patients without cholangitis, need for surgical biliary re-intervention and re-transplantation during a follow-up period of 60 months.
Over a decade, PTCD was attempted in a total of 15 patients, with technical success (93.3%) in 14 patients. Periprocedural complications, including bleeding (7.1%) and cholangitis (21.4%) were observed in patients. During follow-up, both MELD-score (baseline: 13 [8-15] vs. 12 months: 8 [7-8], <0.001) and parameters of cholestasis (GGT: baseline: 286 [47-458] U/L vs. 12 months: 105 [26-147] U/L, =0.024) decreased. Prior to PTCD, cholangitis (64.3%) and cholangiosepsis (21.4%) were common complications. In contrast, following PTCD, cholangitis occurred in only one patient (7.1%). Five patients (35.7%) needed surgical biliary re-intervention and two (14.3%) required re-transplantation.
PTCD in pediatric patients following LTX had an acceptable safety profile, demonstrating a biochemical improvement of both cholestasis and graft function and may prevent cholestatic complications, thus reducing the need for surgical re-intervention and re-transplantation.
胆汁淤积性并发症仍是小儿肝移植（LTX）术后发病的主要原因。由于胆汁引流方式改变，通过内镜逆行胆管造影进行标准胆管通路建立可能不可行。可选择经皮经肝胆道引流（PTCD）。然而，关于PTCD在这些患者中的安全性和有效性的系统数据较少。
在这项回顾性研究中，分析了小儿肝移植术后患者PTCD的操作和安全特征。我们比较了首次PTCD置入前、置入后6个月和12个月时的炎症、胆汁淤积和移植肝功能的实验室指标。通过随访60个月期间无胆管炎、无需手术胆道再次干预和再次移植的患者百分比来分析疗效。
在十年间，共对15例患者尝试进行PTCD，14例患者技术成功（93.3%）。患者出现了围手术期并发症，包括出血（7.1%）和胆管炎（21.4%）。在随访期间，终末期肝病模型（MELD）评分（基线：13[8 - 15] vs. 12个月：8[7 - 8]，<0.001）和胆汁淤积参数（γ-谷氨酰转移酶：基线：286[47 - 458] U/L vs. 12个月：105[26 - 147] U/L，=0.024）均下降。在PTCD之前，胆管炎（64.3%）和胆管脓毒症（21.4%）是常见并发症。相比之下，PTCD之后，仅1例患者发生胆管炎（7.1%）。5例患者（35.7%）需要手术胆道再次干预，2例（14.3%）需要再次移植。
小儿肝移植术后患者的PTCD具有可接受的安全性，显示出胆汁淤积和移植肝功能的生化改善，并可能预防胆汁淤积性并发症，从而减少手术再次干预和再次移植的需求。
