[Multimodality interventional treatments for biliary complications after orthotopic liver transplantation: a preliminary study].
OBJECTIVE
To describe the technique, efficacy, and safety of multimodality interventional treatments for biliary complications after orthotopic liver transplantation (OLT). The core of multimodality interventional treatments is percutaneous transhepatic biliary drainage (PTBD).


METHODS
From January 2006 to May 2008, seventy-two patients with biliary complications afte OLT were closed in our study. On the basis of the cholangiographic appearance, patients were classified into 4 groups: anastomotic biliary strictures (n = 19), hilar biliary strictures (n = 16), multifocal/diffuse biliary strictures (n = 31), and anastomotic biliary fistulae (n = 6). All patients were treated in our hospital, including PTBD only in 6 patients, PTBD combined with balloon dilation in 50 patients, balloon dilation and plastic stent implantation in 10 patients, balloon dilation and metallic stent implantation in 6 patients. Their data were analyzed retrospectively, including serum hemobilirubin, cholangiographic appearance and complications.


RESULTS
PTBD were successful in all cases. The clinical symptoms improved or eliminated were observed in 66 cases, the effective rate was 91.7% (66/72). Among 72 patients, 26 patients were free of drainage tube, 8 patients underwent second PTBD for the obstruction of biliary stents, and 38 patients maintained drainage tube for long-term. In 66 patients with biliary obstruction, the direct bilirubin was (145 +/- 106) micromol/L before treatments and 76 micromol/L +/- 59 micromol/L one month after PTBD (t = 3.78, P < 0.001). The rate of biliary tract infection was 14.3% and 43.8% respectively with the tip of drainage tube placed in biliary duct and in duodenum. There was a significantly statistical difference between these two items (chi(2) = 4.886, P = 0.027).


CONCLUSIONS
PTBD combined with balloon dilation and biliary stent implantation is a effective therapeutic modality for biliary complications after OLT, which can improve patients' clinical symptoms, elevate patients' quality of life. The tip of drainage tube being placed in biliary duct can decrease the rate of biliary tract infection significantly.
Li
Ming-an
MA
Department of Interventional Vascular Radiology, 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
Jiang
Zai-bo
ZB
Huang
Ming-sheng
MS
Shan
Hong
H
Li
Zheng-ran
ZR
Qian
Jie-sheng
JS
Pang
Peng-fei
PF
Zhu
Kang-shun
KS
Guan
Shou-hai
SH
Wu
Chun
C
Chen
Gui-hua
GH
Lu
Min-qiang
MQ
Yang
Yang
Y
Wang
Gen-shu
GS
Yi
Shu-hong
SH
Li
Hua
H
D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*