PURPOSE: Biliary complications (BC) are a common source of morbidity after pediatric liver transplantation (LT). Detailed knowledge about risk factors may help to reduce its incidence.
METHOD: Retrospective analysis for the incidence of biliary complications of 123 pediatric LT-patients of a single institution treated from May 1990 to December 2011. Numerous risk factors for anastomotic and non-anastomotic biliary complications were examined.
RESULTS: Overall, 28 LT were complicated by BC (22.8%): 10 (8.1%) primary anastomotic strictures, 8 (6.5%) anastomotic leaks (all in biliary-enteric anastomoses), 3 (2.4%) non-anastomotic strictures. Risk factors for anastomotic leaks were: total operation time (increased by 26% with every hour the operation lasted longer, p=0.02); and early (<4 weeks postoperative) hepatic artery thrombosis (6-fold risk increase for leak, p=0.03). A risk factor for a primary anastomotic stricture was: type of biliary reconstruction (6-fold risk increase for choledocho-choledochal anastomosis if compared to biliary-enteric anastomosis, p=0.01). Risk factors for non-anastomotic, intra-hepatic strictures were: donor age (risk increase of 9% with each additional year of donor; all donors with age >= 48 years showed strictures, p=0.02); and MELD score (risk increase of 20% with each additional point of MELD score; all patients with MELD >= 30 showed strictures, p=0.01).
CONCLUSION: To avoid morbidity from anastomotic BC in pediatric LT, operation time must be kept as short as possible, choledocho-enteric anastomosis should be preferred to choledocho-choledochal anastomosis, and care must be taken to prevent early hepatic artery thrombosis. Children with a high MELD score present more nonanastomotic, intra-hepatic strictures, and those might be avoided by choosing donors of less than 48 years.