[Biliary complications following orthotopic liver transplantation. The Hungarian experience].
BACKGROUND
The authors summarize the characteristics of biliary complications following liver transplantation in the Hungarian liver transplant program. Aims were to analyze the frequency and the types of biliary complications as well as their effect on the patient and graft survival. The authors observed the known risk factors in the Hungarian practice, and they also try to find unknown risk factors for biliary complications. They review the therapy of biliary complications.


METHODS
In the retrospective study, patients were divided into two groups, with and without biliary complication after liver transplantation. These two groups were compared with many factors, and with the survivals. The biliary complication group was divided into two parts: those who had an early and those with a late biliary complication. These two new groups were also compared with the controls. The results are summarized in tables and statistical figures. Categorical variables are evaluated by chi 2 -test, continuous ones are with Levine Test (for homogenicity of means), Student T test and Mann-Whitney U-test. Cumulative survivals are computed with Kaplan-Meier log rank analysis.


RESULTS
Biliary complication appeared in 25% of the patients. The most frequent complications were stenosis (18%), biliary leakage (9%), biliary necrosis (6%), and ischaemic type of biliary lesions (3%). The 5-year survival is worse when biliary complications were diagnosed (55%) than without such a complication (66%). In the biliary complication group the retransplantation rate was higher (15%). The most frequent treatments were interventional radiologic methods (69%), surgical methods (17%), and the ERCP.


CONCLUSIONS
The rate of biliary complications met the international reviews. Risk factors for biliary complications were cholangitis, hepatic artery thrombosis and stenosis, high rate of intraoperative blood transfusions, and acute rejection. Biliary complications frequently associated with the initial poor function of the transplanted graft. Early biliary complications have a negative impact on patient survival, while late complications influence a decreased quality of life. Biliary complications were treated mostly by interventional radiologic procedures.
Nemes
Balázs
B
Semmelweis Egyetem, Altalános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika Budapest. nemes@trans.sote.hu
Zádori
Gergely
G
Hartmann
Erika
E
Németh
Andrea
A
Fehérvári
Imre
I
Görög
Dénes
D
Máthé
Zoltán
Z
Dávid
Andrea
A
Jakab
Katalin
K
Sárváry
Eniko
E
Piros
László
L
Tóth
Szabolcs
S
Fazakas
János
J
Gerlei
Zsuzsa
Z
Járay
Jeno
J
Doros
Attila
A
D000328:Adult; D000368:Aged; D001646:Bile; D001656:Biliary Atresia / Q000209:etiology; D001659:Biliary Tract / Q000473:pathology* / Q000503:physiopathology; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D002779:Cholestasis / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D006801:Humans; D006814:Hungary; D007511:Ischemia / Q000209:etiology; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D011788:Quality of Life; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors