Comparative study of arterial and biliary complications in pediatric liver transplantation with living and cadaveric donors

Abstract

Introduction: Liver transplantation greatly improved the survival rate of children and adolescents withterminal liver diseases. Patients, who once had a fatal prognosis, today can be submitted to liver transplantation (LxT), with survival rates of approximately 90% in one year. The biliary atresia is the mainindication in the pediatric population and for those for whom underwent a portoenterostomy and did notobtain good results with it, representing more than 50% of children under the age of 2 years in Europeand the U.S, transplantation represents the only remaining therapeutic option with good survival benefit.Advances in clinical care and surgical techniques led to improved survival of patients undergoing livertransplantation, but still the arterial and biliary complications represent the Achilles tendon in the development of this procedure. Moreover, the shortage of organs for the pediatric population motivate thedevelopment of new modalities of liver grafts, such as reduced liver graft, the split-liver transplantationand more recently the living donors. Despite the improved results, vascular arterial and biliary remain animportant cause of morbidity, mortality and graft loss after transplantation. Methods: Survey in Pubmedand Lilacs to gather data related complications of pediatric liver transplantation between 1999 to 2009.Results: In the current study 1485 cases of LxT were performed using cadaveric donors and 505 casesusing living donor’s grafts were statistically analyzed and data was collected. When analyzing the arterialand biliary complications in pediatric liver transplantation using living donor grafts the rates of biliaryfistula was 14.7%, biliary stenosis 3.1% and arterial thrombosis 3.3%. When analyzing the data regarding cadaveric donors it was observed that the rate of arterial thrombosis was 5.7%, biliary fistula 3.7%and biliary stenosis (2.5%). The data was analyzed and compared between the two groups living andcadaveric donors and the results were: biliary fistula (P = 0.0486)*, and the biliary stenosis and hepaticartery thrombosis (P = 0.5167) and (P = 0.6752) respectively. Conclusion: Fistulas and stenosis represent the most frequent biliary complications, especially when using living donors. In the other handarterial complications are more frequent in the group of cadaveric organ grafts.