Diagnosis and management of biliary complications in pediatric living donor liver transplant recipients.
The incidence of biliary complications (BCs) after living donor liver transplantation (LDLT) can reach 40%. Published data on the pediatric population are limited, and treatment protocols vary. Our aim was to describe the clinical scenario for BCs and treatment approaches after LDLT. Between October 1995 and December 2012, 489 pediatric LDLT procedures were performed. BCs developed in 71 patients (14.5%). Biliary strictures (BSs) developed in 45 (9.2%) patients, and bile leaks (BLs) developed in 33 patients (6.7%). The BL diagnosis was clinical in all cases, and 69.7% of the patients underwent surgery. Nearly half of the BS cases had clinical features or suggestive ultrasound findings. Liver biopsy findings suggested BSs in 51.7%. Percutaneous transhepatic cholangiography was performed in 95.6% of the BS patients. The success rate was 77% [mean number of percutaneous biliary interventions (PBIs) = 3.9 ± 1.98, median drainage time = 8 months]. In conclusion, BL patients can be managed with conservative therapy, even though most of these patients will ultimately be treated with surgery. Diagnosing a BS requires a high degree of clinical suspicion because the available resources for its identification can fail in up to 50% of cases. A higher number of PBIs and the use of a drainage catheter for a longer time may be required to achieve better results with this technique.
Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil; Hepatology and Liver Transplantation, Sírio Libanês Hospital, São Paulo, Brazil.
Flávia H
FH
Feier
Paulo
P
Chapchap
Renata
R
Pugliese
Eduardo A
EA
da Fonseca
Francisco C
FC
Carnevale
Airton M
AM
Moreira
Charles
C
Zurstrassen
Aline C
AC
Santos
Irene K
IK
Miura
Vera
V
Baggio
Adriana
A
Porta
Teresa
T
Guimarães
Helry
H
Cândido
Marcel
M
Benavides
Andre
A
Godoy
Katia M R
KM
Leite
Gilda
G
Porta
Mario
M
Kondo
João
J
Seda-Neto
D000293:Adolescent; D016738:Alagille Syndrome / Q000628:therapy; D001656:Biliary Atresia / Q000628:therapy; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography; D003251:Constriction, Pathologic / Q000175:diagnosis* / Q000209:etiology; D004322:Drainage / Q000379:methods; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery; D005355:Fibrosis / Q000628:therapy; D019693:Hepatitis, Autoimmune / Q000628:therapy; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000601:surgery*; D017114:Liver Failure, Acute / Q000628:therapy; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D066027:Transplant Recipients; D020176:Tyrosinemias / Q000628:therapy