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Biliary dilatation and strictures after composite liver-small bowel transplantation in children: defining a newly
M Thamara P R Perera1, Girish L Gupte, Khalid Sharif
1The Liver Unit (including Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom.
Insights
Biliary dilatation and strictures (BDS) are frequent after composite liver-small bowel transplantation (CLSBT) in children. Most cases have benign outcomes, but further study is needed for strictures.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Transplantation Medicine
Background:
- Biliary dilatation and strictures (BDS) are known complications after liver transplantation.
- BDS have not been previously reported in children undergoing composite liver-small bowel transplantation (CLSBT).
Purpose of the Study:
- To describe and classify BDS in children after CLSBT.
- To analyze potential risk factors associated with BDS in this population.
Main Methods:
- A retrospective review of 47 children who underwent CLSBT was conducted.
- Biliary complications were classified based on presentation, location, and required interventions.
- Potential risk factors including recipient size, graft manipulation, and ischemia time were analyzed.
Main Results:
- BDS occurred in 45% of children at a median of 190 days post-transplant.
- Five types of biliary lesions were identified, with sphincter dysfunction-related dilatation being most common (67%).
- No significant association was found between studied variables and BDS development; intervention was needed for stricter types.
Conclusions:
- BDS is a frequent late complication following CLSBT in children, often with a benign course.
- The long-term outcomes for extrahepatic and intrahepatic strictures require further investigation through multicenter studies.
Background:
Biliary dilatation and strictures (BDS) are well recognized after liver transplantation but not reported after composite liver-small bowel transplantation (CLSBT). We aimed to describe and propose a classification of BDS in children undergoing CLSBT and analyze the potential risk factors.
Methods:
Biliary complications of 47 consecutive children undergoing CLSBT were reviewed and classified according to presentation, location, and intervention required. The following variables were studied: small recipient (weight, <10 kg), donor-recipient weight ratio, liver/bowel graft reduction/not, partial/full pancreas, liver/bowel rejection, and median cold ischemia time (>454 min).
Results:
Twenty-one (45%) children developed BDS at median 190 days (22 [7-138] months follow-up). Five distinct biliary lesions were identified. Most of the BDS (14/21; 67%) consisted of sphincter dysfunction-related bile duct dilatation (type I), whereas others (7/21; 33%) comprised extrahepatic bile duct (type II; n=3), hilar (type III; n=1), segmental (type IV; n=1), and diffuse (type V; n=2) intrahepatic strictures. None of the graft reduction strategies or other variables studied demonstrated a significant association with BDS. Therapeutic intervention was required in 1 of 14 type I and four of seven type II to V BDS in the form of percutaneous biliary dilatation with or without drainage.
Conclusion:
This article identifies BDS after CLSBT as a frequent late complication after CLSBT, which has a benign outcome in most cases. The natural history of children with extrahepatic and intrahepatic strictures is not yet clear and will need multicenter prospective studies.
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