{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:32:17Z","timestamp":1790987537447,"version":"4.1.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":396,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>Biliary complications (BCs) still remain the Achilles heel of liver transplantation (LT) with an overall incidence of 10% to 35% in pediatric series. We hypothesized that (1) the use of alternative techniques (reduced size, split, and living donor grafts) in pediatric LT may contribute to an increased incidence of BCs, and (2) surgery as a first treatment option for anastomotic BCs could allow a definitive cure for the majority of these patients. Four hundred twenty-nine primary pediatric LT procedures, including 88, 91, 47, and 203 whole, reduced size, split, and living donor grafts, respectively, that were performed between July 1993 and November 2010 were retrospectively reviewed. Demographic and surgical variables were analyzed, and their respective impact on BCs was studied with univariate and multivariate analyses. The modalities of BC management were also reviewed. The 1- and 5-year patient survival rates were 94% and 90%, 89% and 85%, 94% and 89%, and 98% and 94% for whole, reduced size, split, and living donor liver grafts, respectively. The overall incidence of BCs was 23% (n = 98). Sixty were anastomotic complications [47 strictures (78%) and 13 fistulas (22%)]. The graft type was not found to be an independent risk factor for the development of BCs. According to a multivariate analysis, only hepatic artery thrombosis and acute rejection increased the risk of anastomotic BCs (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001 and <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.003, respectively). Anastomotic BCs were managed primarily with surgical repair in 59 of 60 cases with a primary patency rate of 80% (n = 47). These results suggest that (1) most of the BCs were anastomotic complications not influenced by the type of graft, and (2) the surgical management of anastomotic BCs may constitute the first and best therapeutic option. <jats:italic toggle=\"yes\">Liver Transpl 20:893\u2013903, 2014<\/jats:italic>. \u00a9 2014 AASLD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/lt.23910","type":"journal-article","created":{"date-parts":[[2014,5,9]],"date-time":"2014-05-09T08:58:58Z","timestamp":1399625938000},"page":"893-903","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":75,"title":["Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation"],"prefix":"10.1097","volume":"20","author":[{"given":"Tom","family":"Darius","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jairo","family":"Rivera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Fusaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quirino","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"de Magn\u00e9e","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Bourdeaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Janssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Clapuyt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Reding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R2-6-20250124","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1111\/j.1399-3046.2007.00737.x","article-title":"Liver transplantation in pediatric patients: twenty years of experience at the University of Wisconsin.","volume":"11","author":"DAlessandro","year":"2007","journal-title":"Pediatr Transplant"},{"key":"R3-6-20250124","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1097\/00000658-199809000-00014","article-title":"Longterm results of pediatric liver transplantation: an analysis of 569 transplants.","volume":"228","author":"Goss","year":"1998","journal-title":"Ann Surg"},{"key":"R4-6-20250124","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/S0041-1345(03)00463-9","article-title":"Biliary complications after pediatric liver transplantation revisited.","volume":"35","author":"Heffron","year":"2003","journal-title":"Transplant Proc"},{"key":"R5-6-20250124","first-page":"2893","article-title":"Categories of nonheartbeating donors.","volume":"27","author":"Kootstra","year":"1995","journal-title":"Transplant Proc"},{"key":"R6-6-20250124","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1007\/s003830050328","article-title":"Pediatric liver transplantation: from the fullsize liver graft to reduced, split, and living related liver transplantation.","volume":"13","author":"Otte","year":"1998","journal-title":"Pediatr Surg Int"},{"key":"R7-6-20250124","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/j.1399-3046.2005.00477.x","article-title":"Pediatric liver transplantation using left hepatic segments from living related donors: surgical experience in 100 recipients at SaintLuc University Clinics.","volume":"10","author":"Darwish","year":"2006","journal-title":"Pediatr Transplant"},{"key":"R8-6-20250124","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1097\/SLA.0b013e3182121eb7","article-title":"Impact of pretransplant liver hemodynamics and portal reconstruction techniques on posttransplant portal vein complications in pediatric liver transplantation: a retrospective analysis in 197 recipients.","volume":"254","author":"de Magnee","year":"2011","journal-title":"Ann 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