Biliary Complications in Children Following Living Donor Liver Transplantation: An Observational Retrospective Cohort Study of 330 Cases From a Single Center.

Background: Liver transplantation remains the only treatment for end-stage liver disease and acute liver failure in children. In the pediatric population, the main challenge is the scarcity of deceased donors. To overcome this, partial liver grafts from living donors are utilized to expand the donor pool. This approach, however, is linked with a higher frequency of surgical and biliary complications, occurring in up to 45% of cases. The study aimed to assess the incidence and factors influencing biliary complications in children undergoing liver transplantation from living donors and the impact on long-term transplant success.

Methods: The study included 330 patients who underwent primary liver transplantation from living donors between 1999 and 2017 at the Department of Pediatric Surgery and Organ Transplantation of The Children's Memorial Health Institute. It identifies the types and frequency of biliary complications, risk factors, treatment methods, and impact on graft function and patient survival.

Results: Biliary complications were observed in 22.7% of the patients, including 14.2% of bile leaks and 9,7% of biliary obstructions. No significant risk factors for bile leaks were identified. Risk factors for a biliary stricture included primary liver tumors, multiple graft arteries, operation > 8 h, hepatic artery thrombosis, and acute rejection. Biliary complications did not significantly impact the long-term survival of grafts or recipients.

Conclusions: Biliary complications remain a significant concern in pediatric liver transplants from living donors. Managing these complications requires a tailored approach. Despite these complications, the overall long-term survival of grafts and patients remains unaffected.