Pediatr Transplantation 2014: 18: 786–787
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Pediatric Transplantation DOI: 10.1111/petr.12328
Editorial
Biliary complications after pediatric liver transplantation: The endless heel Biliary reconstruction has been the weak point in liver transplantation since the very early experiences, having traditionally been referred to as the “Achilles’ Heel” of the procedure. The spectrum of biliary complications (BC) includes three different entities: (i) fistula, which are typical of the early post-transplant phase; (ii) strictures arising at the anastomotic site; and (iii) strictures of the intrahepatic ducts, which may occur both at an early and at a later phase. Pediatric patients are in general more prone to these complications, in large part due to the fact that they necessarily receive segmental grafts, either from living or from deceased donors, the latter as split or more rarely reduced organs. When looking at the literature of the last two decades, it is surprising how little improvement the knowledge in this field has seen in terms of incidence, pathogenesis, prevention, and management. In the present volume of Pediatric Transplantation, the Geneva group presents an interesting retrospective analysis of risk factors for BC from a 21-yr experience in 116 patients receiving 123 transplants (1). It is noteworthy that, probably due to meticulous surgical technique and optimal short- and long-term post-transplant care, in spite of a low volume activity of
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Pediatric Transplantation DOI: 10.1111/petr.12328
Editorial
Biliary complications after pediatric liver transplantation: The endless heel Biliary reconstruction has been the weak point in liver transplantation since the very early experiences, having traditionally been referred to as the “Achilles’ Heel” of the procedure. The spectrum of biliary complications (BC) includes three different entities: (i) fistula, which are typical of the early post-transplant phase; (ii) strictures arising at the anastomotic site; and (iii) strictures of the intrahepatic ducts, which may occur both at an early and at a later phase. Pediatric patients are in general more prone to these complications, in large part due to the fact that they necessarily receive segmental grafts, either from living or from deceased donors, the latter as split or more rarely reduced organs. When looking at the literature of the last two decades, it is surprising how little improvement the knowledge in this field has seen in terms of incidence, pathogenesis, prevention, and management. In the present volume of Pediatric Transplantation, the Geneva group presents an interesting retrospective analysis of risk factors for BC from a 21-yr experience in 116 patients receiving 123 transplants (1). It is noteworthy that, probably due to meticulous surgical technique and optimal short- and long-term post-transplant care, in spite of a low volume activity of
