Abstract
Biliary complications are one of the most serious and typical complications of liver transplantation. Optimizing the diagnosis and management of these complications requires a detailed analysis of their incidence, defined as the aim of our study.
Method and group of patients: We made a retrospective analysis of all data in transplant protocols and endoscopic and radiologic reports of 500 consecutive primary transplant procedures. Results: In 443 and 57 cases, the primary reconstruction procedures were choledochocholedochoanastomosis and hepaticojejunoanastomosis, respectively.
Choledochocholedochoanastomosis stenosis was found in 90 patients, of this number, it was combined with leak in 11. Leak was present in 38 patients, occurring within the first 2 months posttransplant in 35 (92%).
Stenosis in the hepatic junction region was diagnosed in 8 patients and choledocholithiasis in 9. In 8 cases, the stenosiswas due to lymphoproliferation.
Papillary stenosis was detected in 5 cases. Twentytwo patients had surgery for biliary peritonitis.
A total of 145 patients had ERCP followed by endoscopic treatment, which was fully successful in 88 out of the 117 (75.2%) patients with anastomotic stenosis or leak. In 13 patients, ERCP was combined with the transhepatic access, and was successful in 6.
Twenty three patientshad hepaticojejunoanastomosis, which was a primary procedure in 16 and a procedure after a failed transhepatic intervention in 7. Repeat transplantation was undertaken in 16 patients.
The final number of patients with hepaticojejunoanastomosis was 96 (19.2%). Of this number, 25 were treated for acute cholangitis, 16 had transhepatic intervention, followed by surgical reconstruction in 7.
Overall, biliary complications were noted in 147 primary transplantation procedures (29.4%).Twenty seven of the 147 (18.4%) patients died (mortality in all 500 transplanted patients was 71, i.e. 14,2%). Conclusion: Biliary complications following liver transplantation were frequent in our series of patients, and were fairly heterogeneous.
While there is no doubt they played a rolein prolonging duration of therapy, increasing need of retransplantations, and therefore costs of treatment, they were not associated with increased mortality. Anaccurate and quick diagnosis is a must as is the availability of all intervention methods, with endoscopic retrograde cholangiopancreatography being the most commonly used one.