title: Steatosis of the hepatic graft as a risk factor for post-transplant biliary complications.
abstract: BACKGROUND
  Despite recent advances in organ preservation, immunosuppression, and surgical techniques, the biliary tree is still considered the Achilles' heel of liver transplantation. The aim of this study is to retrospectively analyze the incidence of biliary complications and identify risk factors that might predispose to the development of biliary problems.
  
  
  METHODS
  From January 2004 to December 2007, 117 consecutive liver transplantations were retrospectively analyzed for the development of biliary complications by the review of medical records. Patients were divided into group 1 with biliary complications (n = 43) and group 2 without biliary complications (n = 74).
  
  
  RESULTS
  The overall biliary complication rate was 36.8% (leakage 6% and stricture 30.8%). Univariate analysis indicated that significant predictors of biliary complications were the time interval between portal and arterial reperfusion (p = 0.037) and macrovacuolar steatosis of the graft > 25% (p = 0.004). Stepwise logistic regression model demonstrated that a macrosteatosis of the graft > 25% (OR = 5.21 CI 95% [1.79-15.15], p = 0.002) was the only independent risk factor predicting biliary complications after liver transplantation. No differences in patient's and graft's survival were noted between the two groups.
  
  
  CONCLUSIONS
  According to our experience, transplanting a liver with > 25% of steatosis is a risk factor for the development of biliary complication.
authors.affiliation: Department of Tissue & Organ Transplantation, University Hospital of Udine, Udine, Italy. umberto.baccarani@uniud.it
authors.forename: Umberto
authors.initials: U
authors.lastname: Baccarani
authors.forename: Miriam
authors.initials: M
authors.lastname: Isola
authors.forename: Gian L
authors.initials: GL
authors.lastname: Adani
authors.forename: Claudio
authors.initials: C
authors.lastname: Avellini
authors.forename: Dario
authors.initials: D
authors.lastname: Lorenzin
authors.forename: Anna
authors.initials: A
authors.lastname: Rossetto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Currò
authors.forename: Chiara
authors.initials: C
authors.lastname: Comuzzi
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Toniutto
authors.forename: Andrea
authors.initials: A
authors.lastname: Risaliti
authors.forename: Franca
authors.initials: F
authors.lastname: Soldano
authors.forename: Vittorio
authors.initials: V
authors.lastname: Bresadola
authors.forename: Dino
authors.initials: D
authors.lastname: De Anna
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bresadola
mesh_terms: D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D005234:Fatty Liver / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D005260:Female; D006084:Graft Rejection; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate