Influence of early biliary complications on survival rates after pediatric liver transplantation-A positive outlook.

Abstract

Early biliary complications (EBC) constitute a burden after pediatric liver transplantation frequently requiring immediate therapy. We aimed to assess the impact of EBC on short- and long-term patient and graft survival as well as post-transplant morbidity. We analyzed 121 pediatric liver transplantations performed between 1984 and 2019 at the Medical University of Innsbruck for the occurrence of early (<90days) biliary complications and investigated the influence of EBC on patient and graft survival. Early biliary complications occurred in 30 (24.8%) out of the 121 pediatric liver transplant recipients. Patient survival at 15years (89.2% vs. 84.2%, p=.65) and all-cause (82.5% vs. 74.0%) and death-censored graft survival (82.5% vs. 75.1%, p=.71) at 10years were similar between the EBC and the non-EBC group. The EBC group had a significantly longer ICU (25 vs. 16days, p<.001) and initial hospital stay (64 vs. 42days, p=.002). Livers of patients with EBC were characterized by multiple bile ducts (33.3% vs. 13.2%, p=.027), and patients with EBC had a higher risk to develop late biliary complications (OR 2.821 [95% CI 1.049-7.587], p=.044) and bowel obstruction/perforation (OR 4.388 [95% CI 1.503-12.812], p=.007). Early biliary complications after pediatric liver transplantation is frequent. The occurrence of EBC significantly increased post-transplant morbidity without affecting mortality. Multiple bile ducts were the only risk factor for the development of EBC in our cohort.