Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Douliou City of Yun-Lin County, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
J Gastrointest Surg. 2019 Apr;23(4):751-759. doi: 10.1007/s11605-018-04076-x. Epub 2019 Jan 10.
The incidence and several risk factors of biliary complication (BC) following pediatric liver transplantation (LT) are widely known, but data on long-term outcomes and management is limited. This retrospective study aimed to investigate the incidence, associated risk factors, management, and outcomes of early and late BC in pediatric LT.
This study enrolled 134 pediatric patients (< 18 years old) who underwent LT at a tertiary care center in Taiwan between January 2001 and December 2015. Diagnosis of BC was based on clinical, biochemical, and radiologic examinations. Clinical data and chart records were reviewed and compared between the groups.
Among the 134 children, 21 children (15.7%) had BC after LT. Nine children had early complications, including leakage plus stricture (n = 2), stricture only (n = 2), and leakage only (n = 5). Twelve children had late BC; all of whom had anastomotic stricture. Of the 21 patients with BC, 11 patients (52.4%) were treated without surgery. The median time of first treatment for BC was 6.5 months (range, 11 days to 6.2 years). Five of the 9 patients with early complications and two of the 12 patients with late complications died of biliary tract infection. The major risk factors of BC in pediatric LT were (1) recipient age > 2 years, (2) Kasai portoenterostomy revision, and (3) hepatic artery thrombosis.
Several risk factors of BC in pediatric LT were identified. Children with early BC appeared to have relatively unfavorable outcomes. However, late BC treated by either radiological or surgical methods appeared to have a relatively good long-term prognosis.
小儿肝移植（LT）后胆系并发症（BC）的发生率和几个危险因素广为人知，但关于长期结果和管理的数据有限。本回顾性研究旨在调查小儿 LT 后早期和晚期 BC 的发生率、相关危险因素、处理和结局。
本研究纳入了 2001 年 1 月至 2015 年 12 月期间在台湾一家三级医疗中心接受 LT 的 134 名小儿患者（<18 岁）。BC 的诊断基于临床、生化和影像学检查。回顾和比较了两组的临床数据和图表记录。
在 134 名儿童中，21 名儿童（15.7%）在 LT 后发生 BC。9 名儿童发生早期并发症，包括漏管伴狭窄（n=2）、单纯狭窄（n=2）和单纯漏管（n=5）。12 名儿童发生晚期 BC，均为吻合口狭窄。在 21 例 BC 患儿中，11 例（52.4%）未经手术治疗。BC 首次治疗的中位时间为 6.5 个月（范围 11 天至 6.2 年）。9 例早期并发症患儿中有 5 例和 12 例晚期并发症患儿中有 2 例因胆道感染死亡。小儿 LT 中 BC 的主要危险因素是（1）受体年龄>2 岁，（2）Kasai 胆肠吻合术修正，和（3）肝动脉血栓形成。
小儿 LT 中 BC 的几个危险因素已确定。早期 BC 患儿的预后似乎较差。然而，通过放射或手术方法治疗的晚期 BC 似乎具有较好的长期预后。
