Staged biliary reconstruction after liver transplantation: A novel surgical strategy for high acuity pediatric transplant recipients. Surgery 2019 Feb;165(2):323-328
Date
10/01/2018Pubmed ID
30268374DOI
10.1016/j.surg.2018.08.022Scopus ID
2-s2.0-85053863845 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
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 JCAuthors
Richard J. Berens MD Professor in the Anesthesiology department at Medical College of WisconsinGeorge M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Joohyun Kim MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin
Stacee Lerret PhD Professor Hybrid in the Pediatrics department at Medical College of Wisconsin
John P. Scott MD 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, MPH Associate Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Anastomosis, Roux-en-YBile Ducts
Body Temperature
Child
Child, Preschool
Choledochostomy
Erythrocyte Transfusion
Female
Graft Survival
Humans
Jejunostomy
Length of Stay
Liver Transplantation
Male
Retrospective Studies
Stents
