# Management of late biliary complications in pediatric liver transplant recipients

## TL;DR

This paper examines the long-term management of biliary complications in pediatric liver transplant recipients, focusing on late complications and treatment strategies.

## Contribution

The study provides insights into managing late biliary complications in pediatric liver transplant patients through case analysis and follow-up strategies.

## Key findings

- Thirteen of 40 patients with over 20 years of follow-up developed biliary complications.
- Eight patients experienced late biliary complications, which were the main focus of the study.
- A conservative approach with close monitoring was found beneficial for a subgroup of patients.

## Abstract

The number of pediatric liver transplant recipients with long-term follow-up exceeding 20 years is steadily increasing. These patients are characterized not only by their extensive medical histories but also by their long future life expectancy. In this context, careful management of post-transplant complications, including biliary issues, is essential. We identified 40 patients from our 193 pediatric transplants performed since the program’s inception in 1995, with more than 20 years of follow-up at our center. Thirteen of these patients developed either early or late biliary complications. Five developed complications within the first post-transplant year, while eight developed late complications, which are the main focus of this study. We detail the management of biliary complications in these patients, providing an in-depth analysis of four case models and an overview of the remaining patients. In addition to the standard interventional options, such as percutaneous bilioplasties and surgical revisions of anastomoses, we identified a subgroup that may benefit from a more conservative approach, provided they are closely monitored through a rigorous follow-up protocol.