The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation.
OBJECTIVE
This study analyzed the incidence and timing of biliary tract complications after orthotopic liver transplantation (OLTx) in 1792 consecutive patients. These results were then compared with those of previously reported series. Finally, recommendations were made on appropriate management strategies.


BACKGROUND
Technical complications after OLTx have a significant impact on patient and graft survival. One of the principal technical advances has been the standardization of techniques for biliary reconstruction. Nonetheless, biliary complications still occur. A 1983 report from the University of Pittsburgh reported biliary complications in 19% of all transplants, and an update in 1987 reported biliary complications in 13.2% of transplants.


METHODS
The medical records of all patients who underwent liver transplantation and were hospitalized between January 1, 1988 and July 31, 1991 were reviewed. The case material consisted of the medical records of 217 patients treated for 245 biliary complications.


RESULTS
Primary biliary continuity was established by either choledochocholedochostomy over a T-tube (C-C, n = 129) or a Roux-en-Y choledochojejunostomy with an internal stent (C-RY, n = 85). The overall incidence for biliary complication in this large series was 11.5%. Strictures (n = 93) and bile leak (n = 58) were the most common complications (69.6%). Most biliary complications (n = 143, 66%) occurred within the first 3 months after surgery. In general, leaks occurred early, and strictures developed later. Bile leaks were equally frequent in both C-C and C-RY (27.1% and 25.9%, respectively); strictures were more common after a C-RY type of reconstruction (36.4% and 52.9%, respectively). Twenty-one patients died, an incidence of 9.6%. Fifteen of the 21 biliary-related deaths were among patients treated for rejection before the recognition of biliary tract pathologic findings.


CONCLUSIONS
Progress has been made on improving the results of biliary reconstruction after OLTx. Nonetheless, patients continue to experience biliary complications after OLTx, and these complications cause considerable loss of grafts and life. If significant additional improvement in patient and graft survival are to be obtained, the technical performance of OLTx must continue to improve.
Greif
F
F
Ichilov Medical Center, Tel Aviv University, Israel.
Bronsther
O L
OL
Van Thiel
D H
DH
Casavilla
A
A
Iwatsuki
S
S
Tzakis
A
A
Todo
S
S
Fung
J J
JJ
Starzl
T E
TE
D000328:Adult; D001646:Bile; D001660:Biliary Tract Diseases / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D002648:Child; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors