title: Analysis of Factors Associated With Biliary Complications in Children After Liver Transplantation.
abstract: Biliary complications (BCs) remain an important cause of morbidity after pediatric liver transplantation. Technical factors have already been implicated in the development of BCs. Previous reports have associated the use of partial grafts, particularly living donor grafts, with a higher incidence of BCs. Our aim is to study the factors associated with the development of BCs in a large cohort of pediatric liver transplant recipients.
  
  
  
  Retrospective cohort study of 670 children (<18 years of age) who underwent a primary liver transplant between March 2000 and January 2015. Patients who did and did not develop BCs were compared with identify associated factors. Univariate and multivariate analyses were performed.
  
  
  
  A total of 115 patients (17.2%) developed BCs (83 strictures and 44 leaks). Of the study participants, 594 had living donor liver transplants. Multiple arterial anastomoses was a protective factor for BCs, and a ductoplasty was a risk factor. Living donor grafts and multiple biliary anastomoses were more frequently associated with leaks. Patients with BCs had a higher reoperation rate and longer hospital stays. There was no difference in patient or graft survival.
  
  
  
  Technical factors play a major role in the development of BCs, particularly leaks. Strictures are more frequently associated with an inadequate arterial supply to the bile duct, and multiple arterial anastomoses may protect children from this complication. The use of partial grafts was not an independent factor for BCs in high-volume centers that are experienced with this technique.
authors.affiliation: 1 Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, Brazil. 2 Hepatology and Liver Transplantation, Hospital Sirio Libanes, São Paulo, Brazil.
authors.forename: Flavia H
authors.initials: FH
authors.lastname: Feier
authors.forename: Joao
authors.initials: J
authors.lastname: Seda-Neto
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: da Fonseca
authors.forename: Helry L L
authors.initials: HL
authors.lastname: Candido
authors.forename: Renata S
authors.initials: RS
authors.lastname: Pugliese
authors.forename: Romerito
authors.initials: R
authors.lastname: Neiva
authors.forename: Marcel R
authors.initials: MR
authors.lastname: Benavides
authors.forename: Paulo
authors.initials: P
authors.lastname: Chapchap
mesh_terms: D000367:Age Factors; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects; D016009:Chi-Square Distribution; D002675:Child, Preschool; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects