Bowel perforation after liver transplantation for biliary atresia: a retrospective study of care in the transition from children to adulthood

Abstract

PurposeWe evaluated the outcomes of liver transplantation (LT) in pediatric and adult patients with biliary atresia (BA). We focused on bowel perforation after LT (BPLT) as the most common surgical complication and analyzed its risk factors.MethodsThis was a retrospective analysis of 70 BA patients who underwent LT. The patients were divided into three groups according to the timing of LT: within the first year of age (Group A), between 1 and 12 years of age (Group B), and after 12 years of age (Group C). The outcomes of LT and the clinical presentations of BPLT were compared. The surgical variables of patients with and without BPLT were analyzed to assess the risk factors.ResultsThe timing of LT did not affect patient survival. The incidence of BPLT was significantly higher in Group C. In Group C, BPLT progressed to severe peritonitis. No cases of BPLT-associated mortality were observed. A multivariate analysis revealed that a prolonged operative time for LT was an independent risk factor (p = 0.03).ConclusionThe clinical course after transplantation was complicated after adolescence. BPLT should be strongly suspected and relaparotomy should be performed in a timely manner for patients undergoing LT after adolescence.

Gastrointestinal perforations and associated risk factors in children after liver transplantation

“…BA is the most common indication in children that will require liver transplantation. 7,9,10 Furthermore, when patients with and without BA in our cohort were evaluated, patients who were transplanted due to BA were younger and their weight was lower. Additional surgery and mesh use are also higher in BA patients.…”

Determination of risk factors affecting mortality in patients with gastrointestinal perforation after pediatric liver transplantation

“…Our decision to perform emergency laparotomies was based on physical examinations, laboratory tests, and radiological imaging. Yanagi et al stated that fever and abdominal pain were reliable symptoms in patients with perforation. Furthermore, the drain fluid was routinely evaluated and the presence of enterococci strongly suggested bowel perforation …”

“…Furthermore, the drain fluid was routinely evaluated and the presence of enterococci strongly suggested bowel perforation. 4 The etiology of GIP following LT is multifactorial. Previous abdominal surgeries and extensive adhesions may result in a difficult dissection and unrecognized electrocautery injuries.…”

“…This may explain the increased incidence of GIP in pediatric patients . The underlying cause of GIP is unclear, but its risk factors include previous laparotomy, prolonged surgery, prolonged portal clamping time, subsequent laparotomy, portal vein thrombosis, pulmonary hypertension, treatment with high‐dose steroids, open abdomen, and CMV infection . One of the major risk factors for GIP is large grafts, which overtake blood supply to the splanchnic area, exposing the intestines to hypoperfusion.…”

Outcomes of paediatric liver transplant for biliary atresia

“…[31][32][33][34] There is discordance in the literature as to whether enteric complications are higher in patients transplanted for BA versus those patients transplanted for other indications. 32,34 Primary liver transplant may be a logical choice for selected patients. There is little evidence for liver transplant as the primary surgery from the outset, as it is not the current standard, but results are promising.…”