Analysis of Factors Associated With Biliary Complications in Children After Liver Transplantation
Flavia H Feier1, Joao Seda-Neto, Eduardo A da Fonseca
11 Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, Brazil. 2 Hepatology and Liver Transplantation, Hospital Sirio Libanes, São Paulo, Brazil.
Insights
Biliary complications after pediatric liver transplants are often linked to technical factors. Multiple arterial anastomoses may protect against these issues, while ductoplasty increases risk.
Area of Science:
- Hepatobiliary Surgery
- Pediatric Transplantation
- Surgical Complications
Background:
- Biliary complications (BCs) are a significant source of morbidity following pediatric liver transplantation.
- Technical surgical aspects are implicated in BC development.
- Previous studies suggest a higher BC incidence with partial, especially living donor, grafts.
Purpose of the Study:
- To investigate factors associated with biliary complications in a large pediatric liver transplant cohort.
- To identify specific technical elements influencing BC development.
Main Methods:
- Retrospective cohort study of 670 pediatric liver transplant recipients (<18 years).
- Comparison of patients with and without BCs to identify risk and protective factors.
- Univariate and multivariate analyses were employed.
Main Results:
- 17.2% of patients developed BCs (83 strictures, 44 leaks).
- Multiple arterial anastomoses were protective; ductoplasty was a risk factor.
- Living donor grafts and multiple biliary anastomoses were linked to leaks; no impact on survival.
Conclusions:
- Technical factors, especially concerning bile duct blood supply, significantly influence BCs like leaks and strictures.
- Multiple arterial anastomoses appear protective against biliary strictures.
- Partial grafts are not an independent risk factor in experienced high-volume centers.
Background:
Biliary complications (BCs) remain an important cause of morbidity after pediatric liver transplantation. Technical factors have already been implicated in the development of BCs. Previous reports have associated the use of partial grafts, particularly living donor grafts, with a higher incidence of BCs. Our aim is to study the factors associated with the development of BCs in a large cohort of pediatric liver transplant recipients.
Methods:
Retrospective cohort study of 670 children (<18 years of age) who underwent a primary liver transplant between March 2000 and January 2015. Patients who did and did not develop BCs were compared with identify associated factors. Univariate and multivariate analyses were performed.
Results:
A total of 115 patients (17.2%) developed BCs (83 strictures and 44 leaks). Of the study participants, 594 had living donor liver transplants. Multiple arterial anastomoses was a protective factor for BCs, and a ductoplasty was a risk factor. Living donor grafts and multiple biliary anastomoses were more frequently associated with leaks. Patients with BCs had a higher reoperation rate and longer hospital stays. There was no difference in patient or graft survival.
Conclusions:
Technical factors play a major role in the development of BCs, particularly leaks. Strictures are more frequently associated with an inadequate arterial supply to the bile duct, and multiple arterial anastomoses may protect children from this complication. The use of partial grafts was not an independent factor for BCs in high-volume centers that are experienced with this technique.
More Related Videos
Related Concept Videos
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:28Kidney Transplant I: Introduction
01:16Hepatic Drug Excretion: Influencing Factors