title: Risk factors for early and late biliary complications in pediatric liver transplantation.
abstract: BC are a common source of morbidity after pediatric LT. Knowledge about risk factors may help to reduce their incidence. Retrospective analysis of BC in 116 pediatric patients (123 LT) (single institution, 05/1990-12/2011, medium follow-up 7.9 yr). One-, five-, and 10-yr survival was 91.1%, no patient died of BC. Prevalence and risk factors for anastomotic and intrahepatic BC were examined. There were 29 BC in 123 LT (23.6%), with three main categories: 10 (8.1%) primary anastomotic strictures, eight (6.5%) anastomotic leaks, and three (2.4%) intrahepatic strictures. Significant risk factors for anastomotic leaks were total operation time (increase 1.26-fold) and early HAT (<30 days post-LT; increase 5.87-fold). Risk factor for primary anastomotic stricture was duct-to-duct choledochal anastomosis (increase 5.96-fold when compared to biliary-enteric anastomosis). Risk factors for intrahepatic strictures were donor age >48 yr (increase 1.09-fold) and MELD score >30 (increase 1.2-fold). To avoid morbidity from anastomotic BC in pediatric LT, the preferred biliary anastomosis appears to be biliary-enteric. Operation time should be kept to a minimum, and HAT must by all means be prevented. Children with a high MELD score or receiving livers from older donors are at increased risk for intrahepatic strictures.
authors.affiliation: Division of Pediatric Surgery, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Lüthold
authors.forename: Neema
authors.initials: N
authors.lastname: Kaseje
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Jannot
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
authors.forename: Dominique C
authors.initials: DC
authors.lastname: Belli
authors.forename: Valérie A
authors.initials: VA
authors.lastname: McLin
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Wildhaber
mesh_terms: D000293:Adolescent; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D002780:Cholestasis, Intrahepatic / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016031:Liver Transplantation / Q000379:methods; D016015:Logistic Models; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors
keywords: biliary complications; pediatric liver transplantation; risk factors