title: Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation.
abstract: Biliary complications (BCs) still remain the Achilles heel of liver transplantation (LT) with an overall incidence of 10% to 35% in pediatric series. We hypothesized that (1) the use of alternative techniques (reduced size, split, and living donor grafts) in pediatric LT may contribute to an increased incidence of BCs, and (2) surgery as a first treatment option for anastomotic BCs could allow a definitive cure for the majority of these patients. Four hundred twenty-nine primary pediatric LT procedures, including 88, 91, 47, and 203 whole, reduced size, split, and living donor grafts, respectively, that were performed between July 1993 and November 2010 were retrospectively reviewed. Demographic and surgical variables were analyzed, and their respective impact on BCs was studied with univariate and multivariate analyses. The modalities of BC management were also reviewed. The 1- and 5-year patient survival rates were 94% and 90%, 89% and 85%, 94% and 89%, and 98% and 94% for whole, reduced size, split, and living donor liver grafts, respectively. The overall incidence of BCs was 23% (n = 98). Sixty were anastomotic complications [47 strictures (78%) and 13 fistulas (22%)]. The graft type was not found to be an independent risk factor for the development of BCs. According to a multivariate analysis, only hepatic artery thrombosis and acute rejection increased the risk of anastomotic BCs (P < 0.001 and P = 0.003, respectively). Anastomotic BCs were managed primarily with surgical repair in 59 of 60 cases with a primary patency rate of 80% (n = 47). These results suggest that (1) most of the BCs were anastomotic complications not influenced by the type of graft, and (2) the surgical management of anastomotic BCs may constitute the first and best therapeutic option.
authors.affiliation: Pediatric Surgery and Transplant Unit, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Darius
authors.forename: Jairo
authors.initials: J
authors.lastname: Rivera
authors.forename: Fabio
authors.initials: F
authors.lastname: Fusaro
authors.forename: Quirino
authors.initials: Q
authors.lastname: Lai
authors.forename: Catherine
authors.initials: C
authors.lastname: de Magnée
authors.forename: Christophe
authors.initials: C
authors.lastname: Bourdeaux
authors.forename: Magdalena
authors.initials: M
authors.lastname: Janssen
authors.forename: Philippe
authors.initials: P
authors.lastname: Clapuyt
authors.forename: Raymond
authors.initials: R
authors.lastname: Reding
mesh_terms: D000293:Adolescent; D016738:Alagille Syndrome / Q000628:therapy; D001656:Biliary Atresia / Q000628:therapy; D001662:Biliary Tract Surgical Procedures; D002648:Child; D002675:Child, Preschool; D002780:Cholestasis, Intrahepatic / Q000628:therapy; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D015994:Incidence; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis; D016896:Treatment Outcome