Surgery 1998 Nov;124(5):901-10

Biliary complications in pediatric living related liver transplantation

Egawa H, Uemoto S, Inomata Y, Shapiro AM, Asonuma K, Kiuchi T, Okajima H, Itou
K, Tanaka K

Department of Transplantation Immunology Transplant Surgery, Kyoto University
Hospital, Japan.

Abstract

BACKGROUND: The goal of this study was to evaluate cause and outcome of biliary
complications occurring after pediatric living related liver transplantation
(LRLT). METHODS: A database of 205 pediatric patients (71 male and 134 female)
undergoing 208 LRLT from June 1990 to April 1996 was reviewed. RESULTS: The
overall incidence of bile duct complications was 13.9% (29 patients). There were
19 bile leaks, 7 anastomotic strictures, 8 intrahepatic biliary complications,
and the bile duct was ligated inadvertently in 2 cases. Logistic regression
analysis revealed hepatic artery thrombosis, ABO incompatible transplantation,
intrapulmonary shunting in recipients, mode of artery reconstruction, and
cytomegalovirus infection were all significant risk factors for biliary
complications. CONCLUSIONS: Avoidance of ABO incompatible transplantation where
possible, routine use of microvascular techniques for hepatic artery
reconstruction to minimize the risk of artery thrombosis, earlier
transplantation for patients with intrapulmonary shunt, and prophylaxis against
cytomegalovirus infection should all reduce the rate of biliary complications
after LRLT in pediatric recipients