Biliary complications in pediatric liver transplantation: Incidence and management over a decade

• Published in: Liver transplantation Vol. 21; no. 8; pp. 1082 - 1090
• Main Authors: Laurence, Jerome M., Sapisochin, Gonzalo, DeAngelis, Maria, Seal, John B., Miserachs, Mar M., Marquez, Max, Zair, Murtuza, Fecteau, Annie, Jones, Nicola, Hrycko, Alexander, Avitzur, Yaron, Ling, Simon C., Ng, Vicky, Cattral, Mark, Grant, David, Kamath, Binita M., Ghanekar, Anand
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.08.2015
• Subjects: Adolescent; Age Factors; Biliary Tract Diseases - diagnosis; Biliary Tract Diseases - epidemiology; Biliary Tract Diseases - mortality; Biliary Tract Diseases - therapy; Child; Child, Preschool; Female; Graft Survival; Hospitals, High-Volume; Humans; Incidence; Infant; Kaplan-Meier Estimate; Liver Transplantation - adverse effects; Liver Transplantation - methods; Liver Transplantation - mortality; Living Donors; Male; Ontario - epidemiology; Reoperation; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Ontario
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1002/lt.24180

This study analyzed how features of a liver graft and the technique of biliary reconstruction interact to affect biliary complications in pediatric liver transplantation. A retrospective analysis was performed of data collected from 2001 to 2011 in a single high‐volume North American pediatric transplant center. The study cohort comprised 173 pediatric recipients, 75 living donor (LD) and 98 deceased donor (DD) recipients. The median follow‐up was 70 months. Twenty‐nine (16.7%) patients suffered a biliary complication. The majority of leaks (9/12, 75.0%) and the majority of strictures (18/22, 81.8%) were anastomotic. There was no difference in the rate of biliary complications associated with DD (18.4%) and LD (14.7%) grafts (P = 0.55). Roux‐en‐Y (RY) reconstruction was associated with a significantly lower rate of biliary complications compared to duct‐to‐duct reconstruction (13.3% versus 28.2%, respectively; P = 0.048). RY anastomosis was the only significant factor protecting from biliary complications in our population (hazard ratio, 0.30; 95% confidence interval, 0.1‐0.85). The leaks were managed primarily by relaparotomy (10/12, 83.3%), and the majority of strictures were managed by percutaneous biliary intervention (14/22, 63.6%). Patients suffering biliary complications had inferior graft survival (P = 0.04) at 1, 5, and 10 years compared to patients without biliary complications. Our analysis demonstrates a lower incidence of biliary complications with RY biliary reconstruction, and patients with biliary complications have decreased graft survival. Liver Transpl 21:1082‐1090, 2015. © 2015 AASLD.