Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society · 2026
Biliary complications in pediatric living donor liver transplantation: An international multicenter analysis of risk and prognostic factors.
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Wang Kaihang, Madadi-Sanjani Omid, Liu Yuan, Raptis Dimitri A, Gunasekaran Vasanthakumar, Rammohan Ashwin, Sakamoto Seisuke, Uchida Hajime, Kaliciński Piotr, Goldaracena Nicolas, van Beekum Cornelius J, Krendl Felix J, Chen Itsuko Chih-Yi, Domenick Bryanna N, Kow Alfred, Soejima Yuji, Furuya Katryn N, Mazariegos George V, Mali Vidyadhar Padmakar, Dunn Stephen, Olthoff Kim, Abu-Gazala Samir, Rand Elizabeth B, Leipnitz Ian, Chen Chao-Long, Balci Deniz, Kirimker Elvan Onur, Nadalin Silvio, Schneeberger Stefan, Sudan Debra L, Schmelzle Moritz, Herden Uta, Fischer Lutz, Sayed Blayne A, Ng Vicky L, Kowalewski Grzegorz, Kasahara Mureo, Rela Mohamed, Broering Dieter C, Xia Qiang, Clavien Pierre-Alain, Li Zhihao
Аннотация
Biliary reconstruction is often considered the Achilles' heel of liver transplantation, yet risk factors and outcomes remain poorly defined, particularly in pediatric living donor liver transplantation (LDLT). This international multicenter study aims to identify predictors of biliary complications and evaluate their impact on long-term outcomes. 2,665 pediatric patients who underwent LDLT between January 2019 and December 2023 across 19 centers were included. Multivariable logistic regression was performed to identify risk factors, while time-dependent Cox models were used to assess impact on survival. The median recipient age was 11 months (IQR: 6.3-34.6) and biliary atresia was the most common diagnosis (59.7%). Bile leak and anastomotic stricture occurred in 3.6% (n=97) and 1.9% (n=51) of patients, respectively. For bile leak, higher donor BMI was an independent predictor (OR 1.09 per kg/m², 95% CI: 1.02-1.17). For anastomotic strictures, longer cold ischemia time was a significant predictor (OR 1.36 per hour, 95% CI: 1.03-1.79). Bile leak (aHR 4.39, 95% CI: 1.04-18.60) and biliary stricture (aHR 6.26, 95% CI: 1.58-24.80) were associated with worse graft survival. Patient survival was not significantly impacted by bile leak and stricture. Early complications more often required surgery, but survival and failure-to-rescue rates were similar regardless of treatment approach. Ultimately, bile leak and anastomotic stricture remain significant threats to graft survival. The identified risk factors offer insights for risk stratification and prevention strategies aimed at improving outcomes in children undergoing LDLT.