AI Article Synopsis
- A strategy to reduce pediatric waiting list mortality includes expanding the use of variant orthotopic liver transplants, which can lead to higher biliary complications, specifically the exclusion of a major bile duct segment.
- Four cases were identified from a database review, showing that percutaneous cholangiography helped diagnose and manage these complications effectively.
- The main approach for treatment involved aggressive diagnosis and surgical revision, successfully salvaging all grafts by restoring biliary continuity.
Article Abstract
Background: A strategy to increase the number of size- and weight-appropriate organs and decrease the paediatric waiting list mortality is wider application of sectional orthotopic liver transplantation (OLT). These technical variants consist of living donor, deceased donor reduced and split allografts. However, these grafts have an increased risk of biliary complications. An unusual and complex biliary complication which can lead to graft loss is inadvertent exclusion of a major segmental bile duct. We present four cases and describe an algorithm to correct these complications.
Methods: A retrospective review of the paediatric orthotopic liver transplantation database (2000-2010) at Washington University in St. Louis/St. Louis Children's Hospital was conducted.
Results: Sixty-eight patients (55%) received technical variant allografts. Four complications of excluded segmental bile ducts were identified. Percutaneous cholangiography provided diagnostic confirmation and stabilization with external biliary drainage. All patients required interval surgical revision of their hepaticojejunostomy for definitive drainage. Indwelling biliary stents aided intra-operative localization of the excluded ducts. All allografts were salvaged.
Discussion: Aggressive diagnosis, percutaneous decompression and interval revision hepaticojejunostomy are the main tenets of management of an excluded bile duct. Careful revision hepaticojejunostomy over a percutaneous biliary stent can result in restoration of biliary continuity and allograft survival.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3244630 | PMC |
| http://dx.doi.org/10.1111/j.1477-2574.2011.00394.x | DOI Listing |
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