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Biliary Complications in Children Following Living Donor Liver Transplantation: An Observational Retrospective Cohort
Mateusz Ciopiński1, Grzegorz Kowalewski1, Marek Stefanowicz1
1Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland.
Insights
Biliary complications occurred in 22.7% of pediatric liver transplants using living donors, but did not impact long-term graft or patient survival. Management requires a tailored approach for these liver transplant cases.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Liver transplantation is crucial for pediatric end-stage liver disease and acute liver failure.
- Living donor liver transplantation (LDLT) is vital due to donor scarcity but has higher complication rates.
- Biliary complications are a significant concern in pediatric LDLT, affecting up to 45% of cases.
Purpose of the Study:
- To determine the incidence of biliary complications in pediatric liver transplants from living donors.
- To identify risk factors associated with biliary complications after pediatric liver transplantation.
- To evaluate the impact of biliary complications on long-term graft and patient survival.
Main Methods:
- A retrospective analysis of 330 pediatric patients undergoing primary liver transplantation from living donors (1999-2017).
- Assessment of biliary complication types, frequency, and identified risk factors.
- Evaluation of treatment strategies and their effect on graft function and survival.
Main Results:
- Biliary complications occurred in 22.7% of patients (14.2% bile leaks, 9.7% biliary obstructions).
- No significant risk factors for bile leaks were found; biliary strictures were linked to primary liver tumors, multiple graft arteries, prolonged operation time, hepatic artery thrombosis, and acute rejection.
- Biliary complications did not significantly affect long-term graft survival or patient survival.
Conclusions:
- Biliary complications are a notable issue in pediatric LDLT, necessitating individualized management strategies.
- Despite the occurrence of biliary complications, overall long-term outcomes for grafts and patients remain positive.
- The study highlights the feasibility of LDLT in children, with complications not compromising long-term success.
Background:
Liver transplantation remains the only treatment for end-stage liver disease and acute liver failure in children. In the pediatric population, the main challenge is the scarcity of deceased donors. To overcome this, partial liver grafts from living donors are utilized to expand the donor pool. This approach, however, is linked with a higher frequency of surgical and biliary complications, occurring in up to 45% of cases. The study aimed to assess the incidence and factors influencing biliary complications in children undergoing liver transplantation from living donors and the impact on long-term transplant success.
Methods:
The study included 330 patients who underwent primary liver transplantation from living donors between 1999 and 2017 at the Department of Pediatric Surgery and Organ Transplantation of The Children's Memorial Health Institute. It identifies the types and frequency of biliary complications, risk factors, treatment methods, and impact on graft function and patient survival.
Results:
Biliary complications were observed in 22.7% of the patients, including 14.2% of bile leaks and 9,7% of biliary obstructions. No significant risk factors for bile leaks were identified. Risk factors for a biliary stricture included primary liver tumors, multiple graft arteries, operation > 8 h, hepatic artery thrombosis, and acute rejection. Biliary complications did not significantly impact the long-term survival of grafts or recipients.
Conclusions:
Biliary complications remain a significant concern in pediatric liver transplants from living donors. Managing these complications requires a tailored approach. Despite these complications, the overall long-term survival of grafts and patients remains unaffected.
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