J Pediatr Surg 1994 Feb;29(2):214-9; discussion 219-20

The spectrum of bile duct complications in pediatric liver transplantation

Peclet MH, Ryckman FC, Pedersen SH, Dittrich VS, Heubi JE, Farrell M, Balistreri
WF, Ziegler MM

Division of Pediatric Surgery, Children's Hospital Medical Center, University of
Cincinnati, OH 45229

Abstract

It has been noted that reduced-size liver transplants are associated with
increased rates of biliary complications, and it has been suggested that some of
these complications can be handled nonoperatively. In a 6-year period, 91
orthotopic liver transplants were performed in 77 children. The medical records
were reviewed to analyze the effect of reduced-size grafts on the incidence of
bile duct complications and to investigate the utility of interventional
radiology techniques for treatment. Forty-two children received 47 whole-organ
transplants, and 35 children received 44 reduced-size transplants. The median
age and weight were greater for children receiving whole-organ transplants (age,
4.25 years; weight, 16 kg) than for those receiving reduced-size grafts (age,
1.0 year; weight, 8 kg). The overall incidence of bile duct complications was
19.5% (n = 15). The incidence was not different between the whole organ group
(17%) and the reduced-size group (16%). Four of the children with bile duct
complications had associated hepatic artery thrombosis, two of whom had another
transplant. Complications included anastomotic stricture (n = 6), anastomotic
leak (n = 5), intraparenchymal biloma (n = 3), and multiple strictures (n = 1).
Twelve of 15 children presented within 3 months of transplantation. Six children
had initial percutaneous drainage or placement of transanastomotic stents
(external). Operative repair was eventually required for all 15 children, three
of whom received a second transplant. There was a 40% incidence of
cytomegalovirus infection involving the liver or extrahepatic bile ducts near
the time of presentation.(ABSTRACT TRUNCATED AT 250 WORDS)