Biliary complications and management in pediatric living donor liver transplantation for underlying biliary atresia
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C-H Lu1, L L-C Tsang, T-L Huang
1Liver Transplantation Program and Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Insights
Biliary complications after pediatric living donor liver transplantation (LDLT) are manageable with interventional radiology, especially for bile leaks and strictures. However, diffuse ischemic biliary destruction presents poor outcomes despite these advanced treatments.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Interventional Radiology
Background:
- Biliary complications pose significant challenges in pediatric liver transplantation.
- Living donor liver transplantation (LDLT) is a crucial option for pediatric patients.
- Evaluating management strategies for biliary complications in pediatric LDLT is essential.
Purpose of the Study:
- To assess the management and outcomes of biliary complications following pediatric living donor liver transplantation (LDLT).
- To analyze the effectiveness of different treatment modalities for various biliary complications.
Main Methods:
- A retrospective review of 157 pediatric LDLT cases for biliary atresia from 1994 to 2010.
- Postoperative monitoring included daily Doppler ultrasound, with CT and MR cholangiography for suspected complications.
- Treatment involved interventional radiological or surgical approaches.
Main Results:
- Ten biliary complications (6.3%) were identified: 3 bile leaks, 4 biliary strictures without vascular issues, and 3 with vascular complications.
- Bile leaks resolved with interventional procedures.
- Biliary strictures without vascular issues were successfully treated with percutaneous transhepatic cholangial drainage (PTCD) or surgical re-anastomosis.
- Two of three vascular complication cases showed improvement with HA occlusion correction and PTCD; one had poor outcomes due to diffuse ischemic biliary destruction.
Conclusions:
- Interventional radiology is effective for managing anastomotic biliary complications in pediatric LDLT.
- Outcomes for diffuse ischemic biliary destruction remain poor, highlighting a need for further research and improved strategies.
Background:
Biliary complications are a major problem in pediatric liver transplantation. The aim of this study was to evaluate the management and outcomes of biliary complication after pediatric living donor liver transplantation (LDLT).
Methods:
From 1994 to 2010, 157 pediatric LDLT due to biliary atresia were performed in our center. Doppler ultrasound was initially performed daily for 2 weeks postoperatively to evaluate biliary and vascular complications. Computed tomography and or magnetic resonance cholangiography were performed when complications were suspected. They were treated using radiological or surgical interventions.
Results:
Among the 157 cases, we observed 10 (6.3%) biliary complications, which were divided into three groups: bile leakage (n=3); biliary stricture without vascular complication (n=4); and biliary stricture with vascular complication (n=3). The three cases bile leakages recovered after interventional procedures. The seven biliary strictures underwent percutaneous transhepatic cholangial drainage (PTCD). All cases without vascular complications were completely cured after PTCD or a subsequent surgical re-anastomosis. In the vascular complication group, early recorrection of the HA occlusion with successful PTCD treatment were performed in two cases, but one other case with diffuse ischemic biliary destruction had a poor result.
Conclusion:
Successful interventional radiographic approaches are effective for anastomotic biliary complications but with poor results in diffuse ischemic biliary destruction.
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