Biliary Complications After Liver Transplantation: Incidence, Risk Factors and Impact on Patient and Graft Survival.
BACKGROUND
Biliary complications (BC) are one of the most frequent surgical complications after liver transplantation. They include biliary stenosis, leaks, choledocolitiasis and sphincter of Oddi dysfunction. These complications can cause graft dysfunction, retrasplantation, or even death. The purpose of this study was to identify factors related to BC.


METHODS
The medical records of all adult patients who underwent their first liver transplantation in our institution from 2005 to 2013 were reviewed, and any BC that required management was recorded. Cumulative incidence of BC was estimated using Kaplan-Meier. Patient and graft survival was compared using the log-rank test. The Cox regression model was used to establish associated factors.


RESULTS
Of the 236 patients who underwent liver transplantation, 41 patients (17.8%) developed BC. Cumulative incidence was 12.9%, 17.2%, and 20%, after 1, 3 and 5 years of the transplantation, respectively. Twenty-six cases of biliary stenosis, 11 of leaks, and 4 of choledocolitiasis were identified. Most patients were managed endoscopically (82.9%). There were no differences in patient or graft survival.


CONCLUSIONS
Biliary stenosis is the most frequent BC. Patients with higher risk of BC were of blood type AB (P < .001), had viral hepatitis (P = .049), or had alcoholic cirrhosis (P = .036). The success with the endoscopic treatment reduced the need for surgical interventions.


CONCLUSIONS
The incidence of BC in our institution is comparable with the incidence reported in other institutions. Further prospective studies with larger series of patients are warranted to identify other factors associated with development of BC.
Transplant Unit, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia. Electronic address: gmejia@cardioinfantil.org.
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Mejía
Transplant Unit, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia.
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Olarte-Parra
Transplant Unit, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia.
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Pedraza
Transplant Unit, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia.
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JB
Rivera
Transplant Unit, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia.
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CA
Benavides
D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000209:etiology* / Q000401:mortality; D002779:Cholestasis / Q000209:etiology / Q000401:mortality; D003105:Colombia / Q000453:epidemiology; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015994:Incidence; D008104:Liver Cirrhosis, Alcoholic / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D012307:Risk Factors