BILIARY-TRACT RECONSTRUCTION - COMPARISON OF DIFFERENT TECHNIQUES AFTER 187 PEDIATRIC LIVER TRANSPLANTATIONS

Biliary complications after liver transplantation are common and cause significant morbidity and mortality. In order to evaluate the complic ations related to differents sort of biliary reconstruction, from Janu ary 1984 to July 1992 we retrospectively analysed 187 consecutive live r transplants in 136 paediatric patients at Addenbrooke's Hospital, Ca mbridge. There were 51 (27.2%) retransplantations. Biliary reconstruct ion consisted of: type 1-common bile duct - Roux loop (CBD-RL); n = 90 (48.1%); type 2-gallbladder conduit - Roux loop (GC-RL), n = 51 (27.2 %); type 3-gallbladder conduit - common bile duct (GC-CBD), n = 20 (10 .6%); type 4-common bile duct - common bile duct (CBD-CBD), n = 18 (9. 6%); and type 5-common bile duct - common bile duct + gallbladder drai nage (CBD-CBD + GB), n = 8 (4.2%). There were, in all 26 biliary compl ications (14%). Of these 26 complications, biliary stricture was the m ost common (17/26; 65.3%) and 6 out of these 17 (35.2%) were associate d with chronic rejection. Hepatic artery thrombosis was directly relat ed to biliary leakage in 6 out of 26 (23.1%) biliary tract complicatio ns. This series demonstrated that type 1 and type 4 reconstructions we re related to fewer biliary complications (9/90, 10% and 2/18; 11%,res pectively) than the other techniques: 8/51 (16%) for GC-RL 5/20 (25%) for GC-CBD and 2/8 (25%) for CBD-CBD + GB (P = 0.09).