Surgical complications in children after liver transplantation.
The frequency of surgical complications after liver transplantation remains high. Sixty transplants were done in 48 patients during 4 years. Eleven patients were retransplanted (re-transplant rate, 20%) for primary nonfunction (6), arterial thrombosis (3), warm ischemia (1), and rejection (2). Right pleural effusions were drained in 13 patients and left ones in 2. Forty-eight re-explorations excluding retransplantation were performed in 20 patients. Twelve laparotomies were for control of postoperative intraabdominal bleeding. The majority of these patients (8/10, 80%) were transplanted with reduced-size grafts. Early postoperative vascular complications were detected in 12 grafts (5 portal vein occlusions, 7 arterial thromboses). All 5 patients with portal vein (PV) occlusions were reexplored, and PV flow was reestablished in all 5. Biliary leaks were diagnosed in 6 patients and were associated with arterial thromboses in 2 cases. Reoperation was required in 4 of 6 patients. Bowel perforation occurred in 4 patients; 2 small bowel, 1 duodenum, and 1 colon. There was 1 postoperative bowel obstruction requiring laparotomy. Two splenectomies were required in 4 patients with splenic infarction. Resection of part of a transplanted liver was done in 1 patient to exclude septic infarcts. Pancreatitis was diagnosed in 4 patients and one required laparotomy for control of pancreatic hemorrhage. Intraabdominal abscesses required open drainage in 2 patients and percutaneous drainage in 4. Seven thoracotomies were done in 6 patients: 5 open lung biopsies, 1 for control of hemorrhage, and 1 for diaphragmatic plication. The current high survival rates following liver transplantation require aggressive surgical management of a myriad of complications and numerous procedures are necessary both as treatment modalities and as diagnostic aids.
Bilik
R
R
Department of Surgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Yellen
M
M
Superina
R A
RA
D000293:Adolescent; D016063:Blood Loss, Surgical; D006502:Budd-Chiari Syndrome / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000150:complications; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D010996:Pleural Effusion / Q000209:etiology / Q000628:therapy; D011183:Postoperative Complications; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy