Steatosis of the hepatic graft as a risk factor for post-transplant biliary complications.
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.
Baccarani
Umberto
U
Department of Tissue & Organ Transplantation, University Hospital of Udine, Udine, Italy. umberto.baccarani@uniud.it
Isola
Miriam
M
Adani
Gian L
GL
Avellini
Claudio
C
Lorenzin
Dario
D
Rossetto
Anna
A
Currò
Giuseppe
G
Comuzzi
Chiara
C
Toniutto
Pierluigi
P
Risaliti
Andrea
A
Soldano
Franca
F
Bresadola
Vittorio
V
De Anna
Dino
D
Bresadola
Fabrizio
F
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