Biliary Complications Following Pediatric Living Donor Liver Transplantation: Risk Factors, Treatments, and Prognosis

Abstract

We present retrospective analysis of our 15-year experience with pediatric living donor liver transplantation (LDLT), focusing on the risk factors, treatments and long-term prognosis for post-transplant biliary complications (BCs). Between May 2001 and December 2017, 290 LDLTs were performed. The median age was 1.4 years old. The median observation period was 8.4 years. Biliary strictures were classified as anastomotic stricture (AS) or non-anastomotic stricture (NAS). Overall incidence of BCs was 18.6%, including AS in 46 cases, NAS in six, and other classifications in two. The mean period to diagnosis of the AS was 641 ± 810 post-operative days. The multivariate analysis showed that hepaticojejunostomy without external stent was an independent risk factor for AS (p=0.011). The first treatments for AS were percutaneous transhepatic biliary drainage (PTBD) in 25 cases, double-balloon enteroscopy (DBE) in 19, and surgical re-anastomosis in 2. The success and recurrence rates of PTBD treatments were 88.9% and 18.8%, respectively. The success and recurrence rates of endoscopic interventions under DBE were 76.8% and 69.9%, respectively. The 15-year graft survival rates in patients with and without AS were 95.7% and 89.1%, respectively (p=0.255), but 2 patients with cholangitis due to multiple NAS underwent re-transplantation. Post-transplant AS can be prevented by hepaticojejunostomy using external stent, and the long-term prognosis is good with early treatments using DBE or PTBD. However, the prognosis of multiple NAS is poor.