Biliary complications in pediatric liver transplantation: Incidence and management over a decade

Abstract

This study analyzed how features of a liver graft and the technique of biliary reconstruction interact to affect biliary complications in pediatric liver transplantation. A retrospective analysis was performed of data collected from 2001 to 2011 in a single high-volume North American pediatric transplant center. The study cohort comprised 173 pediatric recipients, 75 living donor (LD) and 98 deceased donor (DD) recipients. The median follow-up was 70 months. Twenty-nine (16.7%) patients suffered a biliary complication. The majority of leaks (9/12, 75.0%) and the majority of strictures (18/22, 81.8%) were anastomotic. There was no difference in the rate of biliary complications associated with DD (18.4%) and LD (14.7%) grafts (P 5 0.55). Roux-en-Y (RY) reconstruction was associated with a significantly lower rate of biliary complications compared to duct-to-duct reconstruction (13.3% versus 28.2%, respectively; P 5 0.048). RY anastomosis was the only significant factor protecting from biliary complications in our population (hazard ratio, 0.30; 95% confidence interval, 0.1-0.85). The leaks were managed primarily by relaparotomy (10/12, 83.3%), and the majority of strictures were managed by percutaneous biliary intervention (14/22, 63.6%). Patients suffering biliary complications had inferior graft survival (P 5 0.04) at 1, 5, and 10 years compared to patients without biliary complications. Our analysis demonstrates a lower incidence of biliary complications with RY biliary reconstruction, and patients with biliary complications have decreased graft survival. Liver Transpl 21:1082-1090, 2015. V C 2015 AASLD.Received January 12, 2015; accepted April 28, 2015.Liver transplantation (LT) in the pediatric population is a successful means of treating end-stage liver disease, producing excellent long-term outcomes. 1 Bile leaks and anastomotic strictures are the most frequently seen early technical postoperative complications, 2,3 with single-center analyses reporting the rate of biliary complications to range from 10% to 45%. [4][5][6][7][8][9][10][11][12] Registry data from pediatric-focused LT programs in North America report an overall rate of biliary complications of approximately 15%. 2,13 Although

Outcomes after discontinuation of routine use of transanastomotic biliary stents in pediatric liver transplantation at a single site

“…The overall rate of biliary complications in this cohort (23%) is similar to what is reported in the literature . The biliary complication rates according to RTBS use in adults with liver transplants has been studied with RCTs, and conflicting outcomes have been reported.…”

Liver Transplantation in Children With Propionic Acidemia: Medium‐Term Outcomes

“…Therefore, we could not confirm an increased susceptibility for thrombotic events in our PA patients. In addition, the biliary complication rate in our cohort was 14.3%, which is comparable to a rate of 16.7% in children transplanted for other indications . The overall retransplantation rate in children is reported as 13.3%, and in our cohort, it was 14.3% .…”

“…In addition, the biliary complication rate in our cohort was 14.3%, which is comparable to a rate of 16.7% in children transplanted for other indications. (32) The overall retransplantation rate in children is reported as 13.3%, and in our cohort, it was 14.3%. (33) Therefore, we have not shown a particular increase in posttransplant complications in our cohort when compared with LT for other indications.…”

Immunologic benefit of maternal donors in pediatric living donor liver transplantation

“…Initially, reported overall graft and patient survival in LDLT compared to DDLT were similar, but more recently, data have suggested that LDLT results in superior outcomes in both adult and pediatric patients. [5][6][7][8][9][10][11] Indeed, in many centers in Asia, Europe, and Canada, the majority of pediatric LT recipients undergo LDLT. 4,[12][13][14][15] The factors which result in superior outcomes with LDLT versus DDLT have not been well characterized.…”