J. Kim1, M. A. Zimmerman1, S. M. Lerret1, B. Vitola1, J. P. Scott1, G. W. Telega1, J. C. Hong1 1Medical College Of Wisconsin,Milwaukee, WI, USA
Introduction: Biliary complications after pediatric LT, with an incidence rate of up to 45%, remain causes of significant patient morbidity. Staged operative approach in complex hepatobiliary surgery has improved post-operative outcomes. We sought to analyze the utility and outcomes of staged biliary reconstruction after liver transplantation (LT) in high-risk pediatric transplant recipients.
Methods: We conducted an analysis from our prospective database of 39 pediatric LT at our center from January 2013 through August 2017. Median follow-up was 20 months. Peri-transplant variables were compared for Group I: one-stage LT with biliary anastomosis at the time of transplantation (n=6) vs. Group II: two-stage LT with delayed biliary reconstruction (n=33).
Results: Comparing groups I and II, median age (7.3 vs. 4.8 years), weight (27 vs. 19 kg), proportion of urgent LT (50% vs. 67%) and partial graft LT (33% vs. 33%), graft ischemia time (355 vs. 360 mins), intraoperative red blood cell transfusion volume (11 vs. 21 mL/kg) and base deficit (2.2 vs. 4.1 mEq/L) were comparable. Roux-en-Y hepaticojejunostomy was performed in 67% (Group I) and 48% (Group II). There was no biliary complication in both groups. For groups I and II, one–year survival rates for graft (100% vs. 91%, P=0.451) and patient (100% vs. 97%, P=0.660) were comparable.
Conclusion: Our study is the first to report the utility of staged biliary reconstruction after LT in high-risk pediatric transplant recipients. Outcomes of two-stage LT with delayed biliary reconstruction in children are excellent and should be considered in complex LT.