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The spectrum of bile duct complications in pediatric liver transplantation
M H Peclet1, F C Ryckman, S H Pedersen
1Division of Pediatric Surgery, Children's Hospital Medical Center, University of Cincinnati, OH 45229.
Insights
Reduced-size liver grafts did not increase bile duct complications in pediatric liver transplants. While interventional radiology was used, all cases ultimately required operative repair.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Transplantation Immunology
Background:
- Reduced-size liver grafts in pediatric transplantation are linked to higher biliary complication rates.
- Nonoperative management strategies for these complications have been proposed.
Purpose of the Study:
- To evaluate the impact of reduced-size liver grafts on bile duct complications in pediatric orthotopic liver transplantation.
- To assess the effectiveness of interventional radiology in managing these complications.
Main Methods:
- Retrospective review of 91 orthotopic liver transplants in 77 children over 6 years.
- Comparison of bile duct complication incidence between whole-organ and reduced-size grafts.
- Analysis of interventional radiology techniques and outcomes for complication management.
Main Results:
- Overall bile duct complication rate was 19.5% (15/77 children), with no significant difference between whole-organ (17%) and reduced-size (16%) grafts.
- Common complications included anastomotic stricture, leak, and biloma, often presenting within 3 months post-transplant.
- All 15 children with complications eventually required operative repair, despite initial percutaneous drainage or stenting in six.
Conclusions:
- Reduced-size liver grafts in pediatric liver transplantation are not associated with an increased incidence of bile duct complications compared to whole-organ grafts.
- Interventional radiology techniques, while utilized, did not obviate the need for eventual operative repair in managing these biliary complications.
- Hepatic artery thrombosis and cytomegalovirus infection were noted comorbidities in some patients with biliary complications.
Abstract:
It has been noted that reduced-size liver transplants are associated with increased rates of biliary complications, and it has been suggested that some of these complications can be handled nonoperatively. In a 6-year period, 91 orthotopic liver transplants were performed in 77 children. The medical records were reviewed to analyze the effect of reduced-size grafts on the incidence of bile duct complications and to investigate the utility of interventional radiology techniques for treatment. Forty-two children received 47 whole-organ transplants, and 35 children received 44 reduced-size transplants. The median age and weight were greater for children receiving whole-organ transplants (age, 4.25 years; weight, 16 kg) than for those receiving reduced-size grafts (age, 1.0 year; weight, 8 kg). The overall incidence of bile duct complications was 19.5% (n = 15). The incidence was not different between the whole organ group (17%) and the reduced-size group (16%). Four of the children with bile duct complications had associated hepatic artery thrombosis, two of whom had another transplant. Complications included anastomotic stricture (n = 6), anastomotic leak (n = 5), intraparenchymal biloma (n = 3), and multiple strictures (n = 1). Twelve of 15 children presented within 3 months of transplantation. Six children had initial percutaneous drainage or placement of transanastomotic stents (external). Operative repair was eventually required for all 15 children, three of whom received a second transplant. There was a 40% incidence of cytomegalovirus infection involving the liver or extrahepatic bile ducts near the time of presentation.(ABSTRACT TRUNCATED AT 250 WORDS)