Bile duct anastomotic stricture after pediatric living donor liver transplantation
Kenneth S H Chok1, See Ching Chan, Kwong Leung Chan
1Department of Surgery, The University of Hong Kong, Hong Kong, China. kennethchok@yahoo.com.hk
Insights
In pediatric liver transplants, duct-to-duct anastomosis increases the risk of biliary anastomotic stricture (BAS). Hepaticojejunostomy remains the preferred method for bile duct reconstruction, though further research is needed.
Area of Science:
- Hepatobiliary surgery
- Pediatric transplantation
- Gastroenterology
Background:
- Biliary complications, particularly biliary anastomotic stricture (BAS), are significant concerns in pediatric liver transplantation.
- Hepaticojejunostomy is a common technique, while duct-to-duct anastomosis is increasingly used for bile duct reconstruction.
Purpose of the Study:
- To determine the incidence of BAS after pediatric living donor liver transplantation (LDLT).
- To identify risk factors associated with the development of BAS in this patient population.
Main Methods:
- A retrospective review of 78 pediatric patients (<18 years) undergoing LDLT between 1993 and 2010.
- Diagnosis of BAS was confirmed using clinical, biochemical, histological, and radiological assessments.
Main Results:
- The overall incidence of BAS was 16.7% (13 out of 78 patients).
- Patients with duct-to-duct anastomosis had a higher rate of BAS (23.1% of BAS cases).
- Hepatic artery thrombosis and duct-to-duct anastomosis were identified as significant risk factors for BAS.
Conclusions:
- Hepaticojejunostomy is recommended as the preferred method for bile duct reconstruction in pediatric LDLT.
- Larger studies are warranted to validate these findings and further refine surgical strategies.
Background/Purpose:
Hepaticojejunostomy is a well-accepted method, whereas duct-to-duct anastomosis is gaining popularity for bile duct reconstruction in pediatric living donor liver transplantation (LDLT). Biliary complications, especially biliary anastomotic stricture (BAS), are not clearly defined. The aim of the present study is to determine the rate of BAS and its associated risk factors.
Methods:
The study included 78 pediatric patients (<18 years old) who underwent LDLT during the period from end of September 1993 to end of November 2010. The diagnosis of BAS was based on clinical, biochemical, histologic, and radiologic results.
Results:
All patients received left-side grafts. Thirteen patients (16.7%) developed BAS after LDLT. Among them, 3 patients (23.1%) had duct-to-duct anastomosis during LDLT. The median follow-up period for the BAS group and the non-BAS group was 57.8 and 79.5 months, respectively (P = .683). Ten of the patients with BAS required percutaneous transhepatic biliary drainage with or without dilatation for treating the stricture. Multivariable analysis showed that hepatic artery thrombosis and duct-to-duct anastomosis were 2 risk factors associated with BAS.
Conclusion:
In pediatric LDLT, hepaticojejunostomy is the preferred method for bile duct reconstruction, but more large-scale research needs to be done to reconfirm this result.