TY - JOUR
T1 - Management of excluded bile ducts in paediatric orthotopic liver transplant recipients of technical variant allografts
AU - Conzen, Kendra D.
AU - Lowell, Jeffrey A.
AU - Chapman, William C.
AU - Darcy, Michael
AU - Duncan, James R.
AU - Nadler, Michelle
AU - Turmelle, Yumirle P.
AU - Shepherd, Ross W.
AU - Anderson, Christopher D.
PY - 2011/12
Y1 - 2011/12
N2 - 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.
AB - 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.
KW - biliary complications
KW - excluded bile duct
KW - paediatric liver transplantation
KW - technical variant allograft
UR - http://www.scopus.com/inward/record.url?scp=81255135760&partnerID=8YFLogxK
U2 - 10.1111/j.1477-2574.2011.00394.x
DO - 10.1111/j.1477-2574.2011.00394.x
M3 - Article
C2 - 22081926
AN - SCOPUS:81255135760
SN - 1365-182X
VL - 13
SP - 893
EP - 898
JO - HPB
JF - HPB
IS - 12
ER -