Introduction: The improved surgical techniques, antirejection treatment, and postoperative management have made liver transplantation (LT) the treatment of choice for pediatric patients with end-stage liver disease or acute hepatic failure. However, complications can still occur after LT. Gastrointestinal perforation (GIP) after pediatric LT is a rare but mortal complication. The aim of this study was to evaluate the incidence, possible risk factors, clinical presentation, and follow-up of patients with GIP after LT.

Methods: Since 8 December 1988, 552 LT had been performed, and the records of the 266 pediatric patients were retrospectively analyzed for sex, age, primary disease, surgical history prior to transplant, details of the perforation, Child-Turcotte-Pugh score, PELD score, surgical approach, postoperative follow-up, conversion of immunosuppressive drugs, and mortality results.

Results: Sixteen Pediatric patients (6.1%) (age range, 4 months -18 years) experienced GIP after LT. All patients had living donor liver transplants. Seven of these patients had abdominal surgery (aside from LT), 5 had open abdomen (due to large liver graft), and 5 had vascular revisions prior to GIP. The mean time between LT and diagnosis of GIP was 7/9±10.2 days (range, 4-30 days). Perforations were located in the jejunum (n=9), iliem (n=3), jejunum and ileum (n=2), and colon (n=2). All patients were managed by primary repair with 4/0 and 3/0 prolene ligatures. The mean follow-up time was 9.3 years (range, 1 month-18 years). Two patients died of systemic septic shock.

Conclusions: Consensus has been reached regarding previous abdominal surgery, open abdomen, and vascular thrombosis as the most important risk factors for development of GIP after LT. Primary repair for injuries at all GIP sites can be preferred with successful results.

CITATION INFORMATION: Kirnap M, Yildirim S, Moray G, Torgay A, Haberal M. Gastrointestinal Perforation After Liver Transplantation in Pediatric Patients. Am J Transplant. 2017;17 (suppl 3).

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