Biliary Reconstruction with Choledochoduodenostomy is a Safe Alternative in Pediatric Liver Transplantation

Introduction: The reported incidence of biliary complications in pediatric liver transplantation (PLT) ranges from 10% to 40%. One of the variables is the type of biliary reconstruction. The two types commonly used are choledochocholedocostomy(CC) and choledochojejunostomy(CJ). Choledochoduodenostomy(CD) is seldom used, and the literature provides little information on CD outcomes in PLT. The objective of this study was to compare the efficacy of CD with CC and CJ in PLT.

Methods: We conducted a retrospective analysis of 186 consecutive PLTs (<21 years) between 1/2017 and 2/2024 performed at LPCH. CC was performed in 67, CJ in 61, and CD in 44 children, respectively. 

Results: There was no significant difference in the 5-year patient survival(P=0.14). Intraductal stents were used in 95% CD, 100% CJ, and only 6% CC patients. Overall, the CD showed significantly fewer biliary complications than CC and CJ patients (P=0.01, Figure 1). A biliary stricture was observed more frequently in CC patients than CD and CJ, suggesting a beneficial effect of stent use (21% vs. 2% vs. 5% respectively; P<0.001). There were no bile leaks within the CD and CJ patients, while the CC had an incidence of 4%(P=0.06). The incidence of ascending cholangitis in the CC, CD, and CJ was 1%, 5%, and 10%, respectively(P=0.10).  There were 8 (17 %) retained stents in the CD requiring upper endoscopy removal.

Conclusion: Post-operative biliary complications were rare in the CD cohort, suggesting that CD is a suitable and possibly superior type of reconstruction in PLT.