Aims: The aim of our study was: 1) to analyze the complications of percutaneous transhepatic cholangiography (PTC) in pediatric liver transplant (LT) recipients with biliary complications. 2) to identifiy factors associated with the onset of PTC complications.
Methods:  We retrospectively reviewed all pediatric LT recipients (0-18 years at LT), transplanted between 08.2004 and 10.2020 in our center and selected the patients who underwent PTC. We defined as “PTC session” any placement or exchange of a biliary drain, with or without biliary dilatation. “De novo” sessions were first PTC sessions.  “Exchange” sessions were PTC sessions performed through a preexisting biliary drain. All adverse events observed potentially related to the procedure were considered as complications.
After written and informed consent, the following data were collected from patient records: patient, graft, transplant and PTC characteristics were collected from electronic medical records.
PTC sessions were divided into two groups: with and without complications. These groups were compared to identify factors associated with the onset of PTC complications.
Antibiotic prophylaxis was defined as “same day” when the first antibiotic dose was administered on the day of the PTC, and “extended” if it was administered more than 24 hours before the PTC. Any episode of fever >38°C was considered an infectious complication when associated with elevation of inflammatory indices. Univariate data’s were compared by Fischer’s exact test and by Mann-Whitney test and a p-value of 0.05 was considered as significant.
Results: Thirty-five PTC sessions in 11 recipients were identified. There were 19 “de novo” and 16 “exchange” sessions, with a median number of 3 PTCs per patient. Among this patient population the overall incidence of complications after PTC was 17/35 (49%) with 82% of them being infectious complications (14/35). Of these 14, 57% cases (8/14) were found to have positive blood cultures.  Other complications included biliary leak (1/35 6%), hemobilia (1/35 6%) and portal vein thrombosis (1/35 6%). 25/35 (71%) PTCs were conducted on “same day” antibiotic prophylaxis and 10/35 (29%) on a “‘extended” prophylaxis. 13/14 (93%) of infectious complications occurred in patients with “same day” antibiotic prophylaxis, while 1/14 was documented in “extended” prophylaxis (p= 0.028).
Conclusions: PTC is associated with a high rate of post-procedural complications, infections being the most frequent. “‘Extended” antibiotic prophylaxis may play a role in preventing infectious complications after PTC. These findings warrant further investigations as to improve the management of pediatric LT patients undergoing PTC.