Biliary complications and their management in pediatric liver transplantations:: One center's experience

Following living-donor liver transplantation, biliary complications are more prevalent among pediatric patients (< 18 years old), with reported rates varying between 15% and 30%. In this study, we retrospectively analyzed biliary complications observed in 21 pediatric liver transplant patients (16 boys [76.2%], 5 girls [23.8%] of ages 1 to 18 years (mean, 8.3 +/- 5.05 years) between September 2001 and June 2004. Biliary reconstruction was accomplished via a duct-to-duct anastomosis in 12 (57.1%) and a Roux-en-Y hepaticojejunostomy in 9 (42.9%) patients. Postoperative biliary complications were encountered in six (28.5%) patients. Four of the biliary leaks were from a duct-to-duct anastomosis and two from an hepaticojejunostomy. One (4.7%) patient who experienced biliary leakage after a duct-to-duct anastomosis developed stenosis after the leak healed; five (23.8%) had the leakage treated successfully. One patient had biliary leakage from the duct-to-duct anastomosis subsequent to a hepatic artery thrombosis. All patients with biliary leakage were treated without surgery. Mean follow-up time was 10.2 +/- 9.6 months (range, I to 26 months). Three patients died during follow-up; however, these deaths were not related to the biliary complications. Interventional radiologic approaches are effective to biliary complications, even when the anastomoses are heavily disrupted. In cases of biliary complication, percutaneous combined with internal drainage may prevent biliary sepsis and provide long-term patency.