Management of excluded bile ducts in paediatric orthotopic liver transplant recipients of technical variant allografts

Kendra D. Conzen, Jeffrey A. Lowell, William C. Chapman, Michael Darcy, James R. Duncan, Michelle Nadler, Yumirle P. Turmelle, Ross W. Shepherd, Christopher D. Anderson

Research output: Contribution to journalArticle

6 Scopus citations

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.

Original languageEnglish
Pages (from-to)893-898
Number of pages6
JournalHPB
Volume13
Issue number12
DOIs
StatePublished - Dec 2011

Keywords

  • biliary complications
  • excluded bile duct
  • paediatric liver transplantation
  • technical variant allograft

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