Percutaneous transhepatic cholangiography is valuable in the diagnosis and management of biliary complications following pediatric orthotopic liver transplantation, according to a new study published in Pediatric Radiology

Pediatric patients with end-stage liver disease and chronic hepatic diseases such as Alagille syndrome often require a liver transplant, which can sometimes lead to biliary tract complications, some of which can even result in death. It is therefore of great importance to properly diagnose and manage biliary complications following liver transplantation.

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Here, a team of researchers led by Sandro Sironi, MD, report their experience with percutaneous transhepatic cholangiography to manage biliary complications arising after orthotopic liver transplantation in children. Percutaneous transhepatic cholangiography is an X-ray of the bile ducts that can help diagnose the cause of a bile duct blockage. 

The team conducted a retrospective study in which they enrolled all patients aged less than 18 years who underwent percutaneous transhepatic cholangiography to manage biliary complications after orthotopic liver transplantation at a tertiary care center between January 2010 and December 2020.

During this time period, 301 orthotopic liver transplantations were performed at the center. Of these, 78 (26%) resulted in biliary complications, which were managed by interventional radiology. The complications included biliary strictures, bile leaks, biliary stones, iatrogenic biliary obstruction, and vanishing syndrome. The median time between transplantation and the diagnosis of a biliary complication was 6 years. 

“Percutaneous transhepatic cholangiography and biliary duct catheterization were successful in all cases” and led to a low rate of complications, according to the authors. The complications varied among subgroups.

“A wide spectrum of biliary complications can occur after pediatric orthotopic liver transplantation,” the researchers wrote, and they emphasized the importance of percutaneous transhepatic cholangiography in their diagnosis and management.

Approximately 21% to 31% of patients with Alagille syndrome end up requiring a liver transplant to manage their disease.


Dulcetta L, Marra P, Carbone FS, et al. Biliary complications in pediatric liver transplantation: findings of percutaneous transhepatic cholangiography in a large single-center cohort. Pediatr Radiol. Published online February 2, 2022. doi:10.1007/s00247-021-05278-3