Surgical complications and outcome of paediatric liver transplantation: the Singapore experience

Abstract

The purpose of this study was to analyse the early and late results of paediatric liver transplantation (LT), with particular reference to complications that required surgical intervention. The charts of all children who underwent LT between 1990 and 2002 were reviewed retrospectively. Results were analysed with a minimum follow up of 9 months. Thirty-five children have undergone 38 LTs; 22 received grafts from their parents, 16 received cadaveric organs and three children had retransplantation. The ages of the children ranged from 12 to 168 months. Biliary atresia was the most frequent indication for transplant (n=27). Twenty-seven children had complications that required surgical or radiological interventional procedures. Vascular complications included hepatic artery thrombosis (n=2), hepatic vein (HV) thrombosis (n=1), and the majority being portal vein thrombosis (n=6). Bile leaks were observed in eight children. Other complications included intestinal perforation (n=2), intra-abdominal abscesses (n=1), wound dehiscence (n=2), post-operative bleed (n=2), intestinal obstruction (n=2), ventral hernia (n=1), and multiple abdominal wound sinuses (n=1). Three children underwent retransplantation, two for hepatic artery thrombosis with multiple episodes of cholangitis and intrahepatic biliomas and the third was done for hepatic vein thrombosis. Patient and graft survival at 1 year is 81.5 and 74.2%, respectively. Paediatric LT is associated with significant morbidity, the main complications being vascular and biliary.

Antithrombotic management and thrombosis rates in children post–liver transplantation: A case series and literature review

“…The development of vascular thrombosis post–liver transplantation in children results from the interplay of factors that impact the degree of endothelial injury, the quality of blood flow to the graft, and the intercurrent hemostatic balance in the patient. The factors affecting endothelial injury and blood flow have been well documented, such as surgical techniques, graft types, size of the recipient and the graft‐to‐recipient weight ratio, and their impact on the incidence of vascular thrombosis . Thromboprophylaxis post–liver transplant has been demonstrated to reduce regional thrombotic complications in adult patients .…”

Bile duct anastomotic stricture after pediatric living donor liver transplantation

“…Nonetheless, there are other emerging indications (eg, liver tumor, metabolic syndrome, etc) for LT in this group of patients, and the recipient bile duct is intact for duct-to-duct anastomosis (DDA). There are several reports documenting increasing popularity of DDA for biliary reconstruction in pediatric patients [5,6]. However, there is conflicting evidence suggesting that DDA is probably not as good as HJ for pediatric patients because graft regeneration causes stretching and pulling, thereby narrowing the lumen, damaging the duct, and resulting in stricture formation [7].…”

Transileocolic venous balloon dilatation for the management of primary and recurrent portal venous stenosis after living donor liver transplantation in children

“…Some authors described that differences in portal venous diameters between donor and recipient, malrotation of the vessels or kinking of the portal vein may cause portal venous stenosis after liver transplantation [13,14]. In general, its consequences are not so catastrophic as arterial and biliary complications, however, some authors reported it could be a cause of graft failure [6,15,16] and mortality due to life threatening variceal bleeding [17]. Although surgical reconstruction of the stenotic vein may be definitive therapy for symptomatic patients, such intervention can be complicated technically due to the severe adhesion or scar tissue surrounding the graft associated with repeated surgery.…”