Published online Aug 28, 2015. doi: 10.4254/wjh.v7.i18.2162
Peer-review started: May 19, 2015
First decision: June 25, 2015
Revised: July 30, 2015
Accepted: August 10, 2015
Article in press: August 11, 2015
Published online: August 28, 2015
The expanded indications of partial grafts in pediatric liver transplantation have reduced waiting list mortality. However, a higher morbidity is observed, including an increased rate of biliary complications (BCs). Factors such as the type of graft, the preservation methods applied, the donor characteristics, the type of biliary reconstruction, and the number of bile ducts in the liver graft influences the occurrence of these complications. Bile leaks and strictures comprise the majority of post-transplant BCs. Biliary strictures require a high grade of suspicion, and because most children have a bileo-enteric anastomosis, its diagnosis and management rely on percutaneous hepatic cholangiography and percutaneous biliary interventions (PBI). The success rates with PBI range from 70% to 90%. Surgery is reserved for patients who have failed PBI. BCs in children after liver transplantation have a prolonged treatment and are associated with a longer length of stay and higher hospital costs. However, with early diagnosis and aggressive treatment, patient and graft survival are not significantly compromised.
Core tip: Biliary complications in children after liver transplantation cause significant morbidity, which affect quality of life, increase hospital costs and jeopardize the liver graft if they are not treated appropriately. Diagnostic and treatment approaches to the different types of complications are highlighted, as are the technical nuances specific to pediatric recipients.