Risk factors for early and late biliary complications in pediatric liver transplantation

• Published in: Pediatric transplantation Vol. 18; no. 8; pp. 822 - 830
• Main Authors: Lüthold, Samuel C., Kaseje, Neema, Jannot, Anne-Sophie, Mentha, Gilles, Majno, Pietro, Toso, Christian, Belli, Dominique C., McLin, Valérie A., Wildhaber, Barbara E.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.12.2014
• Subjects: Adolescent; Anastomotic Leak - epidemiology; Anastomotic Leak - etiology; biliary complications; Child; Child, Preschool; Cholestasis, Intrahepatic - epidemiology; Cholestasis, Intrahepatic - etiology; Female; Follow-Up Studies; Humans; Incidence; Infant; Infant, Newborn; Liver Transplantation - methods; Logistic Models; Male; Operative Time; pediatric liver transplantation; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prevalence; Proportional Hazards Models; Retrospective Studies; Risk Factors; Tissue Donors; pediatric liver transplantation; risk factors; biliary complications
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.12363

BC are a common source of morbidity after pediatric LT. Knowledge about risk factors may help to reduce their incidence. Retrospective analysis of BC in 116 pediatric patients (123 LT) (single institution, 05/1990–12/2011, medium follow‐up 7.9 yr). One‐, five‐, and 10‐yr survival was 91.1%, no patient died of BC. Prevalence and risk factors for anastomotic and intrahepatic BC were examined. There were 29 BC in 123 LT (23.6%), with three main categories: 10 (8.1%) primary anastomotic strictures, eight (6.5%) anastomotic leaks, and three (2.4%) intrahepatic strictures. Significant risk factors for anastomotic leaks were total operation time (increase 1.26‐fold) and early HAT (<30 days post‐LT; increase 5.87‐fold). Risk factor for primary anastomotic stricture was duct‐to‐duct choledochal anastomosis (increase 5.96‐fold when compared to biliary‐enteric anastomosis). Risk factors for intrahepatic strictures were donor age >48 yr (increase 1.09‐fold) and MELD score >30 (increase 1.2‐fold). To avoid morbidity from anastomotic BC in pediatric LT, the preferred biliary anastomosis appears to be biliary‐enteric. Operation time should be kept to a minimum, and HAT must by all means be prevented. Children with a high MELD score or receiving livers from older donors are at increased risk for intrahepatic strictures.