Liver transplantation: the last measure in the treatment of bile duct injuries.
BACKGROUND
Bile duct injury (BDI) is a severe complication that may arise during the surgical treatment of a benign disease. A significant proportion of cases develop end-stage liver disease and a liver transplant is required. The aim of this study was to analyze the indications and results of liver transplantation as treatment for BDI.


METHODS
Between January 1988 and May 2007, 20 patients with end-stage liver disease secondary to BDI were included on the liver transplant waiting list. Retrospective charts were analyzed and survival was estimated by the Kaplan-Meier test.


RESULTS
Four patients died while on the waiting list and 16 received a transplant. Injury to the bile duct occurred during a cholecystectomy in 13 of 16 patients, with the main cause of the lesion being duct division in six patients and resection in four. All patients had received some surgical treatment (median = 2 procedures) before being considered for a transplant. The liver transplant came from a cadaveric donor for all patients and the median time between BDI and liver transplant was 60 months. Two patients died in the postoperative period and nine had complications. Three patients died in the late postoperative period. Median follow-up was 62 (range = 24-152) months. One-, three-, and five-year survival rates were 81, 75, and 75%, respectively.


CONCLUSIONS
Complex bile duct injuries and bile duct injuries with previous repair attempts can result in end-stage liver disease. In these cases, liver transplantation provides long-term survival.
de Santibañes
Eduardo
E
General Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Esmeralda 1319 4 piso 4 cuerpo, Buenos Aires, 1007 Argentina. eduardo.desantibanes@hospitalitaliano.org.ar
Ardiles
Victoria
V
Gadano
Adrian
A
Palavecino
Martin
M
Pekolj
Juan
J
Ciardullo
Miguel
M
D000328:Adult; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome