Management of biliary tract complications after orthotopic liver transplantation.
BACKGROUND
Despite improved survival, biliary complications remain a significant cause of morbidity following orthotopic liver transplantation. The aim of this study was to review the incidence, treatment and optimum management pathway of biliary complications at the Scottish Liver Transplant Unit.


METHODS
All patient data were collected prospectively onto a database at the Scottish Liver Transplant Unit with review of hospital records for validation.


RESULTS
A total of 379 consecutive orthotopic liver transplants were performed in 333 adult patients between November 1992 and September 2001. Biliary complications occurred in 55 grafts (51 patients) (14.6%) and their incidence decreased with time. Biliary complications occurred in 29 (10.9%) of the 265 choledocho-choledochostomies compared with 14 (25%) of the 56 with T-tubes. Twenty-eight biliary leaks occurred, 22 of which were anastomotic. Seventeen anastomotic leaks were successfully treated non-operatively. Eight patients with biliary leaks subsequently developed an anastomotic stricture. Of the 30 anastomotic strictures, stent insertion was successful in resolving six of 14 (42%) early anastomotic strictures compared with one of 12 (8%) late anastomotic strictures (p = 0.0479). Six (38%) of the 16 early anastomotic strictures required surgery for complete resolution, compared with 12 (86%) of the 14 late anastomotic strictures (p = 0.0106).


CONCLUSIONS
The incidence of biliary complications has decreased with time. The abandonment of choledocho-choledochostomy over a T-tube has been justified. A combination of conservative, endoscopic, and radiological management has been effective in treating biliary leaks and early anastomotic stricture. However endoscopic or radiological stenting was ineffective in the management of late anastomotic strictures, which were best treated by surgical intervention.
Thethy
Sanjeet
S
Scottish Liver Transplant Unit and Clinical and Surgical Sciences (Surgery), Royal Infirmary of Edinburgh, Edinburgh, UK.
Thomson
Benjamin Nj
BNj
Pleass
Henry
H
Wigmore
Stephen J
SJ
Madhavan
Krishnakumar
K
Akyol
Murat
M
Forsythe
John Lr
JL
James Garden
O
O
D000328:Adult; D001660:Biliary Tract Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D011446:Prospective Studies