Biliary complications following adult liver transplantation with routine use of external biliary drainage.
OBJECTIVE
Biliary complications are still common and often related to the use of biliary drains in liver transplant setting. We analyzed the incidence, treatment and outcome of biliary complications following adult orthotopic liver transplantation (OLTx) performed between February 2002 and October 2004.


METHODS
Overall there were 46 OLTx performed in 44 patients. Two cases of primary graft-non-function (one re-graft) and 2 early postoperative deaths were excluded from the study resulting in 42 OLTx performed in 41 patients included in the final analysis. Biliary reconstruction was by duct-to-duct choledochocholedochostomy (DD, n = 37) and Roux-en-Y hepaticojejunostomy (RYHJ, n = 5) performed over an external Levin type biliary drain in all cases.


RESULTS
The overall incidence of biliary complications was 28.6% (12/42). Bile leak was the commonest and occurred in 16.6% (7/42) of transplants, whereas biliary strictures were found in 3 (7.2%) patients. Eight (19%) patients required surgical treatment and one patient died due to a biliary complication (2.4% mortality rate). Majority (7/12) of complications were bile drain related and all of these occurred in patients with DD anastomosis.


CONCLUSIONS
Biliary complications continue to cause significant morbidity after OLTx but rarely result in mortality if early diagnosis and prompt therapy is applied. Majority of biliary complications following DD anastomosis have been related to the use of biliary drains. In view of this and endoscopic expertise available, duct to duct anastomosis without a biliary drain may reduce complication rates and improve outcome.
Wójcicki
Maciej
M
Department of Hepatobiliary Surgery and Liver Transplantation, M. Curie Hospital, Szczecin, Poland. maciejwojcicki@hotmail.com
Lubikowski
Jerzy
J
Zeair
Samir
S
Gasińska
Mariola
M
Butkiewicz
Jacek
J
Czupryńska
Maria
M
Jarosz
Konrad
K
Zasada-Cedro
Katarzyna
K
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D001649:Bile Duct Diseases / Q000453:epidemiology* / Q000628:therapy; D002768:Choledochostomy / Q000009:adverse effects*; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome