Incidence of Cholangitis and Sepsis Associated with Percutaneous Transhepatic Cholangiography in Pediatric Liver Transplant Recipients.

Naire Sansotta,Lorenzo D’Antiga,Ester De Luca,Alessandra Tebaldi,Emanuele Nicastro,Alberto Ferrari

doi:10.3390/antibiotics10030282

Naire Sansotta, Lorenzo D’Antiga + Show 4 more

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https://doi.org/10.3390/antibiotics10030282

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Abstract

Background. Percutaneous transhepatic cholangiography (PTC) is an established treatment in the management of biliary strictures. The aim of our study was to determine the incidence of PTC-related infectious complications in transplanted children, and identify their precise aetiol-ogy. Methods. We retrospectively reviewed all PTC performed from January 2017 to October 2020 in our center. Before the procedure, all patients received antibiotic prophylaxis defined as first line, while second line was used in case of previously microbiological isolation. Cholangitis was defined as fever (>38.5°) and elevated inflammatory markers after PTC, while sepsis included hemodynamic instability in addition to cholangitis. Results. One hundred and fifty-seven PTCs from 50 pediatric recipients were included. The overall incidence of cholangitis and sepsis after PTC was 44.6% (70/157) and 3.2% (5/157), respectively, with no fatal events. Blood cultures yielded positive results in 15/70 cases (21.4%). Enterococcus faecium and Pseudomonas aeruginosa were the most common isolated pathogens. Multidrug-resistant (MDR) pathogens were found in 11/50 patients (22%). Conclusion. PTC is associated with a relatively high rate of post-procedural cholangitis, although with low rate of sepsis and no fatal events. Blood cultures allowed to find a precise aetiology in roughly a quarter of the cases, showing prevalence of Enterococcus faecium and Pseudomonas aeruginosa.

Highlights

Biliary complications are a major source of morbidity after liver transplant (LT), and their reported incidence varies between 5 and 20% in children [1,2]
An international consensus panel defined an upper limit of a five percent sepsis rate as a quality parameter for percutaneous transhepatic biliary drainage (PTBD) [6]
To the best of our knowledge, this is the first pediatric study evaluating the incidence of Percutaneous transhepatic cholangiography (PTC)-related infectious complications and identifying the microbiological culprit in transplanted children

Summary

Introduction

Biliary complications are a major source of morbidity after liver transplant (LT), and their reported incidence varies between 5 and 20% in children [1,2]. Biliary complications are thought not to affect significantly patient and graft survival [3]. The percutaneous access allows to treat these patients through balloon dilatation. PTC has shown low incidence of major complications, with high success rates in adults. Cholangitis and sepsis represented minor issues, treated in most patients [5]. An international consensus panel defined an upper limit of a five percent sepsis rate as a quality parameter for percutaneous transhepatic biliary drainage (PTBD) [6]

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