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Biliary tract complications in pediatric orthotopic liver transplantation
M Lallier1, D St-Vil, F I Luks
1Division of Pediatric General Surgery, Hôpital Sainte-Justine, Montreal, Quebec, Canada.
Insights
Biliary complications occurred in 24.5% of pediatric liver transplants, including leaks and obstructions. Neither graft type nor reconstruction method impacted complication rates, with no deaths linked to biliary issues.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Biliary tract complications are a significant concern in pediatric orthotopic liver transplantation (OLT), affecting 15-30% of cases.
- This study reviews biliary complications in children undergoing OLT since 1986.
Purpose of the Study:
- To analyze the incidence and types of biliary tract complications in pediatric OLT.
- To evaluate the influence of graft type (reduced vs. whole liver) and biliary reconstruction method (choledochocholedochostomy vs. choledochojejunostomy) on complication rates.
Main Methods:
- Retrospective analysis of 53 OLTs in 48 children (mean age 5.3 years).
- Data collected on graft type (reduced liver graft - RLG; whole liver graft - WLG), biliary reconstruction technique (choledochocholedochostomy - CC; choledochojejunostomy - CJ), and complications.
- Complications categorized as leaks, obstructions, or bilomas.
Main Results:
- Overall biliary complication rate was 24.5% (13/53 patients), including 7 leaks and 5 obstructions.
- No deaths were attributed to biliary complications.
- Neither RLG (25.9%) nor WLG (23.1%) showed a significant difference in complication rates.
- CC (25%) and CJ (24%) reconstruction methods also had similar complication rates.
- Complications included T-tube leaks, Roux-en-Y loop leaks, RLG transection margin leaks, CJ kinking, anastomotic strictures, and vanishing bile duct syndrome.
Conclusions:
- Biliary tract complications occur in nearly a quarter of pediatric OLTs but are not associated with mortality.
- The choice between reduced or whole liver grafts, and between choledochocholedochostomy or choledochojejunostomy, does not significantly alter the risk of biliary complications.
Abstract:
Biliary tract complications are reported in 15% to 30% of orthotopic liver transplantations (OLTs). Since 1986, 53 OLTs were done in 48 children with a mean age and weight of 5.3 years and 18.9 kg, respectively. Twenty-seven transplantations (51%) were reduced liver grafts (RLG) and 26 (49%) were whole liver grafts (WLG). Since 1988, 70% of transplantations have been RLG. Choledochocholedochostomy (mean weight, 25 kg) with a T-tube (CC) or choledochojejunostomy (CJ) (mean weight, 14.5 kg) were done in 24 (45%) and 29 (55%) cases, respectively. The overall mortality was 19% but none of the deaths were related to biliary problems. There were 13 biliary tract complications (24.5%) in 11 patients including 7 leaks, 5 obstructions, and 1 intrahepatic biloma. Leaks leading to bile peritonitis were managed with simple suture and drainage and were related to the T-tube (4), to the Roux-en-Y loop (2), and to the transection margin of a RLG (1). Obstruction was documented in 5 cases with none associated with hepatic artery thrombosis (HAT). Stenosis after CC reconstruction (2) required conversion to CJ. Two patients had revision of CJ because of kinking of the common bile duct after a left lateral segment graft and an anastomotic stricture 46 months after OLT. The last patient developed a vanishing bile duct syndrome 4 months posttransplant and is awaiting retransplantation. One patient had multiple episodes of cholangitis after HAT and was retransplanted. Neither the type of grafts (RLG 25.9% v WLG 23.1%) nor the type of biliary reconstruction (CC 25% v CJ 24%) influenced the rate of biliary complications.(ABSTRACT TRUNCATED AT 250 WORDS)