BILIARY COMPLICATIONS IN PEDIATRIC LIVER-TRANSPLANTATION

Biliary tract complications are reported in 15 % to 20 % of orthotopic liver transplantations (OLT). Since 1986, 55 OLT were done in 50 children with a mean age and weight of 5,6 years and 18,8 kg respectively. There were 28 (51 %) reduced liver grafts (RLG) and 27 (49 %) whole liver grafts (WLG). Since starting using RLG in 1988, 70 % of transplantations have been RLG. Choledochocholedochostomy with a T-tube (CC) or choledochojejunostomy (CJ) were done in 25 (45 %) and 30 (55 %) cases, respectively. The overall mortality was 19 % with one death related to biliary problems. There were 14 biliary tract complications (25 %) in 12 patients including 7 leaks, 6 obstructions and one intrahepatic biloma. Leaks leading to bile peritonitis were managed with simple suture and drainage and were related to the T-tube (4, to the Roux-en-Y loop (2) and the transection margin of a RLG (1). Obstruction was documented in 6 cases, none of which were associated with hepatic artery thrombosis (HAT). Stenosis after CC reconstruction (3) required conversion to CJ. Two patients had revision of CJ because of kinking of the common bile duct and an anastomotic stricture 46 months after OLT. One patient developed a vanishing bile duct syndrome 4 months post-transplant and died while waiting for retransplantation. One patient had multiple episodes of cholangitis after HAT and was retransplanted. The rate of biliary complications was not influenced by neither the type of graft (RLG: 25 % vs WLG: 25,9 %) nor the type of biliary reconstruction (CC: 28 % vs CJ: 23 %). RLG was not associated with an increased risk of biliary leak at the transection margin and the only case in our series improved after correction of a distal anastomotic obstruction. Biliary tract complications can be decreased by meticulous surgical technique and selective use of T-tube drainage during OLT.