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Biliary Complications Following Pediatric Living Donor Liver Transplantation

Risk Factors, Treatments, and Prognosis

Sanada, Yukihiro MD, PhD1; Katano, Takumi MD1; Hirata, Yuta MD1; Yamada, Naoya MD1; Okada, Noriki MD, PhD; Ihara, Yoshiyuki MD, PhD1; Mizuta, Koichi MD, PhD1

doi: 10.1097/TP.0000000000002572
Original Clinical Science—Liver

Background. We present retrospective analysis of our 15-year experience with pediatric living donor liver transplantation, focusing on the risk factors, treatments, and long-term prognosis for posttransplant biliary complications (BCs).

Methods. Between May 2001 and December 2017, 290 living donor liver transplantations 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-AS (NAS).

Results. Overall incidence of biliary complications was 18.6%, including AS in 46 cases, NAS in 6, and other classifications in 2. The mean period to diagnosis of the AS was 641 ± 810 postoperative 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 reanastomosis in 2. The success and recurrence rates of PTBD treatments were 90.9% and 22.7%, respectively. The success and recurrence rates of endoscopic interventions under DBE were 93.6% and 75.3%, 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 retransplantation.

Conclusions. Posttransplant 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.

1 Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan.

Received 2 February 2018. Revision received 26 September 2018.

Accepted 3 October 2018.

The authors declare no funding or conflicts of interest.

The abstract of this article was accepted for oral presentation at the 18th Congress of the European Society for Organ Transplantation; September 24-27, 2017; Barcelona, Spain.

Y.S. has conceived the study design, collected the data, performed the analysis, and drafted the article. T.K., Y.H., N.Y., N.O., and Y.I. have collected the data. K.M. has performed the critical revision of the article for important intellectual content.

Yukihiro Sanada, MD, PhD, Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi 329-0498, Japan. (

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