title: Biliary complications following orthotopic liver transplantation: a 10-year audit.
abstract: BACKGROUND
  Biliary complications following liver transplantation result in major morbidity. We undertook a 10-year audit of the incidence, management and outcomes of post-transplant biliary complications at the New Zealand Liver Transplant Unit.
  
  
  METHODS
  Prospectively collected data on 348 consecutive liver transplants performed between February 1998 and October 2008 were reviewed. The minimum follow-up was 6 months.
  
  
  RESULTS
  A total of 309 adult and 39 paediatric transplants were performed over the study period. Of these, 296 (85%) were whole liver grafts and 52 (15%) were partial liver grafts (24 split-liver, eight reduced-size and 20 live-donor grafts). There were 80 biliary complications, which included 63 (18%) strictures and 17 (5%) bile leaks. Partial graft, a paediatric recipient and a Roux-en-Y biliary anastomosis were independent predictors of biliary strictures. Twenty-five (40%) strictures were successfully managed non-operatively and 38 (60%) required surgery (31 biliary reconstructions, three segmental resections and four retransplants). Seven (41%) bile leaks required surgical revision and 10 (59%) were managed non-operatively. There was no mortality related directly to biliary complications.
  
  
  CONCLUSIONS
  Biliary complications affected one in five transplant recipients. Paediatric status, partial graft and Roux-en-Y anastomosis were independently associated with the occurrence of biliary strictures. Over half of the affected patients required surgical revision, but no mortality resulted from biliary complications.
authors: National Hospital of Sri Lanka and New Zealand Liver Transplant Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka, nalakagunawansa@yahoo.co.uk
authors: Nalaka
authors: N
authors: Gunawansa
authors: John L
authors: JL
authors: McCall
authors: Andrew
authors: A
authors: Holden
authors: Lindsay
authors: L
authors: Plank
authors: Stephen R
authors: SR
authors: Munn
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