[Arterial and biliary complications of hepatic transplantation].
Despite progress in standardization of reconstruction procedures, arterial and biliary complications remain an important problem in liver transplantation. These complications directly affect graft survival and patient mortality. We review a series of 165 consecutive orthoptic liver transplantations performed in 146 patients including 3 children. Biliary reconstruction included bilio-biliary termino-terminal anastomosis in 88% of the cases and bilio-digestive choledoco-jejunal anastomosis in 12%. Biliary complications occurred in 15% (25/165) with more obstruction (64%, 16/25) than leakages (64%, 7/25); 28% (7/25) of these complications were related to biliary drainage (3 obstructions and 4 leakages). There were no arterial complications in the 7 patients with non-anastomotic biliary stenosis. The rate of arterial complications was 11%; with 8 stenoses, 5 thrombosis and 5 pseudoaneurysms. Among the 18 transplantations with an arterial complication, 7 (39%) also had a biliary complication. Among the 10 patients with a complete interruption of arterial blood flow (thrombosis or surgical ligature or a ruptured pseudo-aneurysm), 5 (50%) also had a biliary complication, 1 underwent early retransplantation and 2 died early. In conclusion, the biliary tree of the graft are particularly susceptible to interrupted arterial flow. Ischaemic biliary lesions predominate in the intra-hepatic biliary ducts. Biliary drainage is important.
Carles
J
J
Unité de transplantation hépatique, Hôpital Pellegrin, Bordeaux.
Dubuisson
V
V
Bernard
P
P
Lebail
B
B
Grenier
N
N
Saric
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001158:Arteries; D001660:Biliary Tract Diseases / Q000209:etiology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002768:Choledochostomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D014652:Vascular Diseases / Q000209:etiology* / Q000601:surgery
Complications artérielles et biliaires de la transplantation hépatique.