Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 28, 2015; 7(18): 2162-2170
Published online Aug 28, 2015. doi: 10.4254/wjh.v7.i18.2162
Biliary complications after pediatric liver transplantation: Risk factors, diagnosis and management
Flavia H Feier, Eduardo A da Fonseca, Joao Seda-Neto, Paulo Chapchap
Flavia H Feier, Eduardo A da Fonseca, Joao Seda-Neto, Paulo Chapchap, Hepatology and Liver Transplantation, Hospital Sirio Libanes, 01308050 Sao Paulo, Brazil
Author contributions: All authors contributed equally to this work.
Conflict-of-interest statement: There are no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Flavia H Feier, MD, Transplant Surgeon, Hepatology and Liver Transplantation, Hospital Sirio Libanes, Adma Jafet 115, 01308050 Sao Paulo, Brazil.
Telephone: +55-51-81890439 Fax: +55-51-32484036
Received: May 15, 2015
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.

Keywords: Outcomes, Live-donor, Infants, Strictures, Bile leaks

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.