Abstract
There is little information about the outcomes of pediatric patients with hepatolithiasis after living donor liver transplantation (LDLT). We retrospectively reviewed hepatolithiasis after pediatric LDLT. Between May 2001 and December 2020, 310 pediatric patients underwent LDLT with hepaticojejunostomy. Treatment for 57 patients (18%) with post-transplant biliary strictures included interventions through double-balloon enteroscopy (DBE) in 100 times, percutaneous transhepatic biliary drainage (PTBD) in 43, surgical re-anastomosis in 4, and repeat liver transplantation in 3. The median age and interval at treatment were 12.3 years old and 2.4 years after LDLT, respectively. At the time of treatments, 23 patients (7%) had developed hepatolithiasis of whom 12 (52%) were diagnosed by computed tomography before treatment. Treatment for hepatolithiasis included intervention through DBE performed 34 times and PTBD 6, including lithotripsy by catheter 23 times, removal of plastic stent in 8, natural exclusion after balloon dilatation in 7, and impossibility of removal in 2. The incidence of recurrent hepatolithiasis was 30%. The 15-years graft survival rates in patients with and without hepatolithiasis were 91% and 89%, respectively (p = 0.860). Although hepatolithiasis after pediatric LDLT can be treated using interventions through DBE or PTBD and its long-term prognosis is good, the recurrence rate is somewhat high.
Highlights
Liver transplantation (LT) is an established curative treatment for pediatric patients with end-stage liver disease or acute liver failure
Few studies have analyzed the incidence of hepatolithiasis after LT in pediatric recipients
The suggested risk factors for hepatolithiasis after living donor liver transplantation (LDLT) in pediatric recipients made clear hepaticojejunostomy, internal stent placed during LDLT, plastic stent placed after treatment for posttransplant anastomotic biliary stricture, and non-anastomotic biliary stricture
Summary
Liver transplantation (LT) is an established curative treatment for pediatric patients with end-stage liver disease or acute liver failure. The reported incidence of biliary complications after living donor liver transplantation (LDLT) is 10–35% in pediatric recipients [1,2,3,4,5,6]. The reported incidence of hepatolithiasis or biliary cast syndrome after LT is 2.1–9.1% in adult recipients [7,8,9,10]. The suggested risk factors for hepatolithiasis or biliary cast syndrome after LT include acute cellular rejection, prolonged warm ischemic time, and others [7,8,9,10]. Few studies have analyzed the risk factors for hepatolithiasis after LT in pediatric recipients
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