title: Biliary complications in pediatric liver transplantation: Incidence and management over a decade.
abstract: This study analyzed how features of a liver graft and the technique of biliary reconstruction interact to affect biliary complications in pediatric liver transplantation. A retrospective analysis was performed of data collected from 2001 to 2011 in a single high-volume North American pediatric transplant center. The study cohort comprised 173 pediatric recipients, 75 living donor (LD) and 98 deceased donor (DD) recipients. The median follow-up was 70 months. Twenty-nine (16.7%) patients suffered a biliary complication. The majority of leaks (9/12, 75.0%) and the majority of strictures (18/22, 81.8%) were anastomotic. There was no difference in the rate of biliary complications associated with DD (18.4%) and LD (14.7%) grafts (P = 0.55). Roux-en-Y (RY) reconstruction was associated with a significantly lower rate of biliary complications compared to duct-to-duct reconstruction (13.3% versus 28.2%, respectively; P = 0.048). RY anastomosis was the only significant factor protecting from biliary complications in our population (hazard ratio, 0.30; 95% confidence interval, 0.1-0.85). The leaks were managed primarily by relaparotomy (10/12, 83.3%), and the majority of strictures were managed by percutaneous biliary intervention (14/22, 63.6%). Patients suffering biliary complications had inferior graft survival (P = 0.04) at 1, 5, and 10 years compared to patients without biliary complications. Our analysis demonstrates a lower incidence of biliary complications with RY biliary reconstruction, and patients with biliary complications have decreased graft survival.
authors.affiliation: Liver Transplant Program.|Multi-Organ Transplant Program.|Division of General Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Jerome M
authors.initials: JM
authors.lastname: Laurence
authors.affiliation: Liver Transplant Program.|Multi-Organ Transplant Program.|Division of General Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Sapisochin
authors.affiliation: Liver Transplant Program.
authors.forename: Maria
authors.initials: M
authors.lastname: DeAngelis
authors.affiliation: Liver Transplant Program.|Multi-Organ Transplant Program.|Division of General Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: John B
authors.initials: JB
authors.lastname: Seal
authors.affiliation: Liver Transplant Program.|Divisions of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Mar M
authors.initials: MM
authors.lastname: Miserachs
authors.affiliation: Liver Transplant Program.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Max
authors.initials: M
authors.lastname: Marquez
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Murtuza
authors.initials: M
authors.lastname: Zair
authors.affiliation: Liver Transplant Program.|Divisions of General Surgery.
authors.forename: Annie
authors.initials: A
authors.lastname: Fecteau
authors.affiliation: Liver Transplant Program.|Divisions of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Nicola
authors.initials: N
authors.lastname: Jones
authors.affiliation: Liver Transplant Program.|Divisions of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hrycko
authors.affiliation: Liver Transplant Program.|Divisions of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Avitzur
authors.affiliation: Liver Transplant Program.|Divisions of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Ling
authors.affiliation: Liver Transplant Program.|Divisions of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Ng
authors.affiliation: Liver Transplant Program.|Divisions of General Surgery.|Multi-Organ Transplant Program.|Division of General Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Cattral
authors.affiliation: Liver Transplant Program.|Divisions of General Surgery.|Multi-Organ Transplant Program.|Division of General Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Grant
authors.affiliation: Liver Transplant Program.|Divisions of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Binita M
authors.initials: BM
authors.lastname: Kamath
authors.affiliation: Liver Transplant Program.|Divisions of General Surgery.|Multi-Organ Transplant Program.|Division of General Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Anand
authors.initials: A
authors.lastname: Ghanekar
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D061847:Hospitals, High-Volume; D006801:Humans; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D019520:Living Donors; D008297:Male; D009864:Ontario / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome