Biliary complications in pediatric liver transplantation: A 18 year single center experience in 429 cases

Rivera, Jairo Darius, Tom [UCL] Fusaro, Fabio De Magnee, Catherine [UCL] Ciccarelli, Olga [UCL] Lerut, Jan [UCL] Janssen, Magda Reding, Raymond [UCL] et al.[show all]

Background: Biliary complications (BC) still constitute the “Achilles heel” of pediatric liver transplantation (LTx). The aim of this study was to describe the incidence of BC and analyze the impact of surgical treatment of BC on longterm patient and graft survival. Patients and Methods: We retrospectively reviewed 429 primary LTx performed between 01/07/1993 and 01/12/2010 (226 post-mortem and 203 living donors). The median recipient age was 1.6 years (range: 0.2 - 17.5). The main indications for LTx were biliary atresia (58%) and progressive familial intra-hepatic cholestasis (8%). The median follow-up was 7.6 years. Results: The 1, 5, and 10-year patient and graft survivals were 98%, 95% and 94%, and 97%, 94% and 92%, respectively. The 1 and 5-year survival without BC was 81.2% and 75.5%, respectively. At 5 years, the overall incidence of BC was 23% (n=98), including 60 anastomotic complications (47 strictures and 13 fistulae). Among these 60 BC, surgically treatment was done in 59 cases (98.3%). The recurrence rate of surgical treated BC was 20% (n=12). The 1, 5 and 10-year patient and graft survival of surgically treated BC were comparable with recipients without BC (p=0.553 and p=0.398, respectively). Conclusion: Despite the favorable outcome of pediatric LTx, BC still represent a major source of morbidity, the majority being anastomotic complications. Our results suggest that surgical management of anastomotic BC may constitute the best therapeutic option in terms of subsequent patient/graft survival.