Liver transplantation across Rh blood group barriers increases the risk of biliary complications.
BACKGROUND
Cold ischemia time and the presence of postoperative hepatic arterial thrombosis have been associated with biliary complications (BC) after liver transplantation. An ABO-incompatible blood group has also been suggested as a factor for predisposal towards BC. However, the influence of Rh nonidentity has not been studied previously.


METHODS
Three hundred fifty six liver transplants were performed from 1995 to 2000 at our hospital. BC incidence and risk factors were studied in 345 patients.


RESULTS
Seventy patients (20%) presented BC after liver transplantation. Bile leakage (24/45%) and stenotic anastomosis (21/30%) were the most frequent complications. Presence of BC in Rh-nonidentical graft-host cases (23/76, 30%) was higher than in Rh-identical grafts (47/269, 17%) (P=0.01). BC was also more frequent in grafts with arterial thrombosis (9/25, 36% vs 60/319, 19%; P=0.03) and grafts with cold ischemia time longer than 430 min (26/174, 15% vs 44/171, 26%; P=0.01). Multivariate logistic regression confirmed that Rh graft-host nonidentical blood groups [RR=2(1.1-3.6); P=0.02], arterial thrombosis [RR=2.6(1.1-6.4); P=0.02] and cold ischemia time longer than 430 min [RR=1.8(1-3.2); P=0.02] were risk factors for presenting BC.


CONCLUSIONS
Liver transplantation using Rh graft-host nonidentical blood groups leads to a greater incidence of BC.
Busquets
Juli
J
Department of Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain. jbusquets@csub.scs.es
Castellote
Jose
J
Torras
Jaume
J
Fabregat
Juan
J
Ramos
Emilio
E
Llado
Laura
L
Rafecas
Antonio
A
de la Banda
Esmeralda
E
Figueras
Juan
J
D000368:Aged; D001649:Bile Duct Diseases / Q000209:etiology*; D001787:Blood Group Incompatibility / Q000150:complications*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology; D008297:Male; D012204:Rh-Hr Blood-Group System; D012307:Risk Factors; D014019:Tissue Donors
D012204:Rh-Hr Blood-Group System