title: Evolution of biliary complications after liver transplantation: a single European series.
abstract: BACKGROUND
  The aim of this study was to analyze the evolution of biliary complications over 20 years among adult patients undergoing liver transplantation (OLT) at our institution.
  
  
  METHODS
  Between 1985 and 2007, we performed 1000 OLT in 789 adults and 211 children. To ascertain the evolution of biliary complications among adult OLT from October 1988 to September 2007, we compared the first 100 to with the last 200 adult OLT.
  
  
  RESULTS
  Duct-to-duct was the most common biliary anastomosis performed in both periods (1st; 89% and 2nd; 94%; P = NS). However, a T-tube was used more frequently in the first period (1st; 46% vs 2nd; 6.6%; P < .001). The remaining cases underwent a hepaticojejunostomy (1st; 11% vs 2nd; 7.6%). Biliary complications were more frequent in the first period (1st; 20% vs 2nd; 9%; P < .01). In the first period, the use of a T-tube caused 32% of complications, all of them being bile leaks; but there were none in the second period. Arterial thrombosis or strictures were related to biliary complications in 10% and 33.3% among the first and second periods, respectively. The severity of complications according to the Clavien classification was similar in both periods: IIIa, 15% versus 33.3%; IIIb, 55% versus 55.5%; and IV, 15% versus 11.1%, respectively (P = NS).
  
  
  CONCLUSIONS
  The biliary complication rate among adult patients post-OLT decreased over 20 years at our institution, probably owing to the abandonment of the routine use of a T-tube as well as to advances in immunosuppressive protocols, organ preservation, and preoperative patient management.
authors.affiliation: HBP Surgery and Transplants Department, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain. amaia814@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Gantxegi
authors.forename: M
authors.initials: M
authors.lastname: Caralt
authors.forename: I
authors.initials: I
authors.lastname: Bilbao
authors.forename: L
authors.initials: L
authors.lastname: Castells
authors.forename: J L
authors.initials: JL
authors.lastname: Lázaro
authors.forename: L
authors.initials: L
authors.lastname: Llopart
authors.forename: I
authors.initials: I
authors.lastname: Díez
authors.forename: C
authors.initials: C
authors.lastname: Dopazo
authors.forename: G
authors.initials: G
authors.lastname: Sapisochín
authors.forename: M
authors.initials: M
authors.lastname: Pérez
authors.forename: R
authors.initials: R
authors.lastname: Charco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001660:Biliary Tract Diseases / Q000209:etiology* / Q000601:surgery; D002648:Child; D005060:Europe; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D055815:Young Adult