WOFAPS 2025 8th World Congress of Pediatric Surgery

Prapapin Wettayavanit ¹, Chollasak Thirapattaraphan ¹, Suporn Treepongkaruna ²

¹ Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
² Division of Pediatrics Gastroenterology and Hepatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand

Purposes : To identify the prevalence and factors associated with biliary complications in pediatric LT (liver transplant). Factors were classified into 3 major factors ; patient, surgical and post-operative complications.

Methods : This study is a retrospective study of 132 children who underwent LT in a single center from January 2014 to December 2022. Medical records were reviewed. All biliary complications, including onset, symptoms, imaging, and management were collected. Patients with and without biliary complications were compared. Univariate and multivariate analyses were performed to identify risk factors. Patients with incomplete medical records were excluded.

Results : Of the 121 included patients, 40 patients (33.1%) developed biliary complications (13 strictures and 32 leaks). Patients with biliary complications had higher post-LT albumin level [mean (SD) 35.6+5.6 vs. 31.9+6.4, p=0.002]. In biliary leakage patients, there was more intraoperative albumin used [median (IQR) 1500(1000,2000) vs. 1000(750,1700), p=0.004] and higher blood loss [median (IQR) 280(132,701) vs. 176(95,325), p=0.042]. These findings were not found significant in biliary stricture group. Univariate analysis showed higher intraoperative albumin used and higher blood loss were risk factors for biliary leakage [OR (95% CI) 1.88(1.19-2.98) p=0.007], [OR (95% CI) 2.49(1.01-6.19) p=0.048]. Only intraoperative albumin used was significant in multivariate analysis [OR (95% CI) 1.72(1.00-2.95) p=0.049]. In biliary stricture group, there were more patients with intraabdominal complication such as chylous ascites, hemorrhage and bowel perforation (53.9% vs 23.2%, p 0.018). Univariate analysis showed intraabdominal complication was risk factor for biliary stricture [OR (95% CI) 4.36(1.32-14.41) p=0.016] and this was also significant in multivariate analysis [OR (95% CI) 4.2(1.24-14.12) p=0.020].

Conclusions : Giving too much intraoperative albumin can associated with biliary leakage. Intraabdominal complication after liver transplant can associated with developing biliary stricture.