An analysis of postoperative complications in children with biliary atresia after liver transplantation

Objective To investigate the postoperative complications and prognosis of children with biliary atresia treated with liver transplantation.Methods A retrospective analysis was performed for the clinical data of 41 children with biliary atresia who underwent primary liver transplantation in The Affiliated Children's Hospital of Chongqing Medical University from June 2006 to April 2014.Among these children,28 underwent living donor liver transplantation( LDLT) and 13 underwent liver transplantation from donation after cardiac death( DCD) donors.The children undergoing LDLT or DCD liver transplantation were followed up for 67- 90 months and 15- 56 months,respectively.The complications in the perioperative period and follow- up and prognosis were analyzed.The Fisher's exact test was used for comparison of categorical data between groups.Results Perioperative complications mainly included vascular complications,intra- abdominal hemorrhage,intestinal perforation,rejection reaction,and infection.The incidence of hepatic artery thrombosis in DCD groups was significantly higher than LDLT groups( P = 0.02).A total of 10 children died in the perioperative period,among whom 4 underwent LDLT( 1died of hepatic artery thrombosis,1 underwent DCD liver transplantation due to hepatic artery thrombosis and later died of primary graft failure,1 died of suffocation caused by vomiting,and 1 died of multiple organ failure) and 6 underwent DCD liver transplantation( 1 child each died of hepatic artery thrombosis,pulmonary Klebsiella pneumoniae infection,septic shock after intestinal leakage,circulatory failure,severe capillary leak syndrome,and primary graft failure).During the follow- up,4 children undergoing LDLT died,among whom 2 died of hepatic vein stenosis,1 died of biliary tract infection,and 1 died of biliary stricture.No children undergoing DCD liver transplantation died or experienced complications during follow- up.Conclusion Various complications after liver transplantation in children with biliary atresia are important factors affecting the success rate of liver transplantation and long- term survival rates.Early prevention,early diagnosis,and timely treatment are very important to improve the prognosis of children undergoing liver transplantation.