Biliary complications after pediatric liver transplantation revisited
T G Heffron1, T Pillen, D Welch
1Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Insights
Pediatric liver transplantation (PLT) complications are reduced by technical advances. Partial liver grafts carry a higher risk of biliary complications than whole grafts, but most can be managed non-surgically.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Biliary complications significantly increase morbidity and mortality in pediatric liver transplantation (PLT).
- Understanding risk factors and management strategies is crucial for improving outcomes in PLT.
Purpose of the Study:
- To evaluate the incidence and types of biliary complications in pediatric liver transplantation.
- To compare complication rates between partial and whole liver grafts.
- To assess the effectiveness of different management strategies for biliary complications.
Main Methods:
- Prospective data collection on 89 consecutive PLTs in 82 children.
- Tracking of transplant type, recipient demographics, anastomosis technique, and biliary complications.
- Evaluation of surgical versus interventional radiology treatments for complications.
Main Results:
- Biliary complications occurred in 11.2% of grafts, including strictures (40%) and bile leaks (50%).
- Partial liver grafts had a significantly higher complication rate (19.6%) compared to whole grafts (2.3%) (P = .015).
- No significant difference in complication rates was observed based on ductal anastomosis type.
Conclusions:
- Technical advancements have decreased the incidence of biliary complications in PLT.
- Partial liver grafts present a statistically higher risk of biliary complications than whole grafts.
- Most pediatric biliary complications can be effectively managed with radiological intervention, avoiding surgical re-exploration and without impacting graft survival.
Background:
Biliary complications in pediatric liver transplantation (PLT) are associated with increased morbidity and mortality.
Methods:
Prospectively, data was collected on 89 consecutive liver transplants performed in 82 children. Eighty-nine consecutive PLTs were tracked for transplant type (partial versus whole), recipient age/weight, duct anastomosis type, surgical technique, and biliary complications. Treatments of biliary complications (surgical versus interventional radiology) were also evaluated.
Results:
Forty-six children (51.7%) received partial transplants and 43 (48.3%) children received whole organs. The average age for whole liver transplanted children was 8.95 +/- 6.62 years and average weight was 36.2 +/- 28.7 kg; for those receiving partial livers, 3.19 +/- 3.52 years and 14.1 +/- 13.0 kg. Duct-to-duct anastomosis was performed for 26 grafts and Roux-en-Y choledochojejunostomy for 63 grafts. Biliary complications occurred in 10 of 89 (11.2%) grafts. Complications included anastomotic strictures in four (40%), bile leak in five (50%), intraparenchymal biloma in one (10%). The complication rate for whole organs was 1/43 (2.3%) and 9/46 (19.6%) for partial organ (P =. 015). No difference in complication rates were seen in type of ductal anastomosis (7.7% vs 12.7%, P = NS). Reoperation for biliary complication was necessary in only 2/10 (20%) of grafts.
Conclusions:
Technical advances have reduced the incidence of biliary complications in PLT. Partial liver grafts have a statistically higher risk of biliary complication than whole grafts. Most biliary complications can be managed with radiological intervention without surgical exploration. Pediatric biliary complications are not associated with graft loss.