Bile duct anastomotic stricture after pediatric living donor liver transplantation.
OBJECTIVE
Hepaticojejunostomy is a well-accepted method, whereas duct-to-duct anastomosis is gaining popularity for bile duct reconstruction in pediatric living donor liver transplantation (LDLT). Biliary complications, especially biliary anastomotic stricture (BAS), are not clearly defined. The aim of the present study is to determine the rate of BAS and its associated risk factors.


METHODS
The study included 78 pediatric patients (<18 years old) who underwent LDLT during the period from end of September 1993 to end of November 2010. The diagnosis of BAS was based on clinical, biochemical, histologic, and radiologic results.


RESULTS
All patients received left-side grafts. Thirteen patients (16.7%) developed BAS after LDLT. Among them, 3 patients (23.1%) had duct-to-duct anastomosis during LDLT. The median follow-up period for the BAS group and the non-BAS group was 57.8 and 79.5 months, respectively (P = .683). Ten of the patients with BAS required percutaneous transhepatic biliary drainage with or without dilatation for treating the stricture. Multivariable analysis showed that hepatic artery thrombosis and duct-to-duct anastomosis were 2 risk factors associated with BAS.


CONCLUSIONS
In pediatric LDLT, hepaticojejunostomy is the preferred method for bile duct reconstruction, but more large-scale research needs to be done to reconfirm this result.
Department of Surgery, The University of Hong Kong, Hong Kong, China. kennethchok@yahoo.com.hk
Kenneth S H
KS
Chok
See Ching
SC
Chan
Kwong Leung
KL
Chan
William W
WW
Sharr
Paul K H
PK
Tam
Sheung Tat
ST
Fan
Chung Mau
CM
Lo
D000293:Adolescent; D000714:Anastomosis, Surgical; D001649:Bile Duct Diseases / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D001652:Bile Ducts / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007583:Jejunum / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D012307:Risk Factors