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Staged biliary reconstruction after liver transplantation: A novel surgical strategy for high acuity pediatric transplant recipients. Surgery 2019 02;165(2):323-328

Date

10/01/2018

Pubmed ID

30268374

DOI

10.1016/j.surg.2018.08.022

Scopus ID

2-s2.0-85053863845   3 Citations

Abstract

INTRODUCTION: Biliary complications after pediatric orthotopic liver transplantation remain causes of significant patient morbidity. Staged operative approach in complex hepatobiliary surgery has improved postoperative outcomes but has not been evaluated in pediatric orthotopic liver transplantation. We sought to analyze the outcomes of staged biliary reconstruction after orthotopic liver transplantation in high acuity patients.

METHODS: A retrospective analysis of 43 pediatric orthotopic liver transplantations at our center (January 2013 through December 2017). Median follow-up was 25 months. Variables were compared for group I: 1-stage orthotopic liver transplantation with biliary anastomosis (n = 6) versus group II: staged biliary reconstruction orthotopic liver transplantation (n = 37).

RESULTS: Comparing groups I and II, median age (7.3 vs 4.8 years), weight (27 vs 19 kg), proportion of urgent orthotopic liver transplantation (50% vs 65%), partial graft orthotopic liver transplantation (33% vs 35%), and intraoperative red blood cell transfusion volume (11 vs 21 mL/kg) were comparable. Roux-en-Y hepaticojejunostomy was performed in 67% (group I) and 49% (group II). There was no biliary complication in both groups. For groups I and II, 3-year survival rates for graft (100% vs 92%, P = .477) and patient (100% vs 97%, P = .679) were comparable.

CONCLUSION: Our study showed excellent outcomes with staged biliary reconstruction orthotopic liver transplantation in high acuity pediatric transplant recipients. This is the first report showing clinical applicability of staged biliary reconstruction orthotopic liver transplantation in children.

Author List

Kim J, Zimmerman MA, Lerret SM, Scott JP, Voulgarelis S, Fons RA, Vitola BE, Telega GW, Hoffman GM, Berens RJ, Hong JC

Authors

Richard J. Berens MD Professor in the Anesthesiology department at Medical College of Wisconsin
Roger A. Fons MD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Stacee Lerret PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin
John P. Scott MD Associate Professor in the Anesthesiology department at Medical College of Wisconsin
Grzegorz W. Telega MD Professor in the Pediatrics department at Medical College of Wisconsin
Bernadette Vitola MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Stylianos Voulgarelis MD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin
Michael A. Zimmerman MD, FACS Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Anastomosis, Roux-en-Y
Bile Ducts
Body Temperature
Child
Child, Preschool
Choledochostomy
Erythrocyte Transfusion
Female
Graft Survival
Humans
Jejunostomy
Length of Stay
Liver Transplantation
Male
Retrospective Studies
Stents
jenkins-FCD Prod-486 e3098984f26de787f5ecab75090d0a28e7f4f7c0