Bile duct anastomotic stricture after pediatric living donor liver transplantation

• Published in: Journal of pediatric surgery Vol. 47; no. 7; pp. 1399 - 1403
• Main Authors: Chok, Kenneth S.H, Chan, See Ching, Chan, Kwong Leung, Sharr, William W, Tam, Paul K.H, Fan, Sheung Tat, Lo, Chung Mau
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2012
• Subjects: Adolescent; Anastomosis, Surgical; Bile Duct Diseases - epidemiology; Bile Duct Diseases - etiology; Bile Duct Diseases - mortality; Bile Duct Diseases - therapy; Bile duct stricture; Bile Ducts - surgery; Child; Child, Preschool; Constriction, Pathologic - epidemiology; Constriction, Pathologic - etiology; Constriction, Pathologic - mortality; Constriction, Pathologic - therapy; Female; Follow-Up Studies; Hepaticojejunostomy; Humans; Infant; Jejunum - surgery; Kaplan-Meier Estimate; Liver - surgery; Liver Transplantation - methods; Living donor liver transplantation; Living Donors; Logistic Models; Male; Multivariate Analysis; Pediatric liver transplantation; Pediatrics; Percutaneous transhepatic biliary drainage; Postoperative Complications - epidemiology; Postoperative Complications - mortality; Postoperative Complications - therapy; Risk Factors; Surgery; Bile duct stricture; Pediatric liver transplantation; Percutaneous transhepatic biliary drainage; Living donor liver transplantation; Hepaticojejunostomy
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2011.12.014

Abstract Background/Purpose Hepaticojejunostomy is a well-accepted method, whereas duct-to-duct anastomosis is gaining popularity for bile duct reconstruction in pediatric living donor liver transplantation (LDLT). Biliary complications, especially biliary anastomotic stricture (BAS), are not clearly defined. The aim of the present study is to determine the rate of BAS and its associated risk factors. Methods The study included 78 pediatric patients (<18 years old) who underwent LDLT during the period from end of September 1993 to end of November 2010. The diagnosis of BAS was based on clinical, biochemical, histologic, and radiologic results. Results All patients received left-side grafts. Thirteen patients (16.7%) developed BAS after LDLT. Among them, 3 patients (23.1%) had duct-to-duct anastomosis during LDLT. The median follow-up period for the BAS group and the non-BAS group was 57.8 and 79.5 months, respectively ( P = .683). Ten of the patients with BAS required percutaneous transhepatic biliary drainage with or without dilatation for treating the stricture. Multivariable analysis showed that hepatic artery thrombosis and duct-to-duct anastomosis were 2 risk factors associated with BAS. Conclusion In pediatric LDLT, hepaticojejunostomy is the preferred method for bile duct reconstruction, but more large-scale research needs to be done to reconfirm this result.