BILIARY COMPLICATIONS IN PEDIATRIC LIVER- TRANSPLANTATION

Biliary tract complications are reported in 15 % to 20 % of orthotopic liver transplantations (OLT). Since 1986, 55 OLT were done in 50 chil dren with a mean age and weight of 5,6 years and 18,8 kg respectively. There were 28 (51 %) reduced liver grafts (RLG) and 27 (49 %) whole l iver grafts (WLG). Since starting using RLG in 1988, 70 % of transplan tations have been RLG. Choledochocholedochostomy with a T-tube (CC) or choledochojejunostomy (CJ) were done in 25 (45 %) and 30 (55 %) cases , respectively. The overall mortality was 19 % with one death related to biliary problems. There were 14 biliary tract complications (25 %) in 12 patients including 7 leaks, 6 obstructions and one intrahepatic biloma. Leaks leading to bile peritonitis were managed with simple sut ure and drainage and were related to the T-tube (4, to the Roux-en-Y l oop (2) and the transection margin of a RLG (1). Obstruction was docum ented in 6 cases, none of which were associated with hepatic artery th rombosis (HAT). Stenosis after CC reconstruction (3) required conversi on to CJ. Two patients had revision of CJ because of kinking of the co mmon bile duct and an anastomotic stricture 46 months after OLT. One p atient developed a vanishing bile duct syndrome 4 months post-transpla nt and died while waiting for retransplantation. One patient had multi ple episodes of cholangitis after HAT and was retransplanted. The rate of biliary complications was not influenced by neither the type of gr aft (RLG: 25 % vs WLG: 25,9 %) nor the type of biliary reconstruction (CC: 28 % vs CJ: 23 %). RLG was not associated with an increased risk of biliary leak at the transection margin and the only case in our ser ies improved after correction of a distal anastomotic obstruction. Bil iary tract complications can be decreased by meticulous surgical techn ique and selective use of T-tube drainage during OLT.