BILIARY COMPLICATIONS OF REDUCED-ORGAN LIVER-TRANSPLANTATION

Reduced-organ liver transplantation for children is effective in lower ing pretransplantation morbidity and mortality, Improvements in surgic al technique have reduced vascular complications; however, biliary com plications continue to account for significant posttransplantation mor bidity, This investigation chronicles the incidence and type of biliar y complications encountered with reduced-organ liver transplantation. Retrospective review of reduced-organ liver recipients over a 59-month period was performed, and biliary complications were classified as (1 ) missed biliary radicle, (2) anastomotic leak requiring revision, and (3) biliary stricture. From July 1992 to May 1997, 42 children receiv ed reduced-organ grafts: 32 living-donor, 8 cadaveric-reduced, 1 split -liver, and 1 auxiliary orthotopic liver transplant. Of the 42 grafts, 41 were Couinaud segments II/III and 1 was segments II/III/IV, Ten bi liary complications were identified in 9 recipients (24%), Biliary com plications included parenchymal radicle leaks, 5 (50%); biliary strict ures, 3 (30%); and anastomotic leaks, 2 (20%). Although technical adva nces have reduced the incidence of biliary complications secondary to organ ischemia, parenchymal radicle leaks continue to be a source of m orbidity for reduced-organ recipients. Planned exploration on posttran splantation day 7 was performed on the most recent 26 of the 42 total reduced-organ procedures as a mechanism to identify and treat early te chnical complications, Planned exploration as a routine component of r educed-organ transplantation has yielded a 15% incidence of discovered parenchymal leaks and a 5% incidence of discovered anastomotic leaks, This series underscores the necessity for improved anatomical studies to correctly identify duct territories and the development of accurat e noninvasive methods to assess the biliary system preoperatively and intraoperatively in the application of reduced-organ liver transplanta tion. Copyright (C) 1998 by the American Association for the Study of Liver Diseases.