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Intestinal perforation after pediatric liver transplantation: risk factors and management

P Barila1, J A Molino1, E Hidalgo2

  • 1Pediatric Surgery and Urology Department. Vall d'Hebron Hospital Campus. Barcelona (Spain).

Cirugia Pediatrica : Organo Oficial De La Sociedad Espanola De Cirugia Pediatrica
|April 24, 2023
PubMed

Insights

Intestinal perforation (IP) after pediatric liver transplant (PLT) is rare but serious. Key risk factors include younger age, lower weight, prior surgery, and biliary atresia (BA), necessitating prompt surgical intervention to improve outcomes.

Area of Science:

  • Pediatric Surgery
  • Hepatology
  • Gastroenterology

Background:

  • Intestinal perforation (IP) is a rare but severe complication following pediatric liver transplant (PLT).
  • High mortality rates associated with IP post-PLT underscore the need for further investigation.

Purpose of the Study:

  • To identify risk factors associated with intestinal perforation after pediatric liver transplant.
  • To evaluate the management strategies for intestinal perforation in PLT patients.

Main Methods:

  • Retrospective study analyzing data from January 2014 to October 2020.
  • Inclusion of all pediatric liver transplant cases with identified intestinal perforations.

Main Results:

  • Four cases of IP were identified in 102 PLT recipients (3.9%).
  • Risk factors identified include younger age, lower weight, prior laparotomy, and biliary atresia (BA).
  • Three colonic perforations in BA patients were repaired with suture; one patient with hemochromatosis (HC) with necrotizing enterocolitis died.

Conclusions:

  • IP post-PLT is infrequent, with age, weight, prior surgery, and BA as potential risk factors.
  • Timely diagnosis and urgent laparotomy are crucial for reducing mortality.
  • Successful management of isolated IP may not adversely impact long-term outcomes post-PLT.
Abstract

Keywords:
Intestinal perforationLiver transplantationPediatric liver transplant

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