title: Biliary complications following liver transplantation: Single-center experience over three decades and recent risk factors.
abstract: OBJECTIVE
  To identify independent risk factors for biliary complications in a center with three decades of experience in liver transplantation.
  
  
  METHODS
  A total of 1607 consecutive liver transplantations were analyzed in a retrospective study. Detailed subset analysis was performed in 417 patients, which have been transplanted since the introduction of Model of End-Stage Liver Disease (MELD)-based liver allocation. Risk factors for the onset of anastomotic biliary complications were identified with multivariable binary logistic regression analyses. The identified risk factors in regression analyses were compiled into a prognostic model. The applicability was evaluated with receiver operating characteristic curve analyses. Furthermore, Kaplan-Meier analyses with the log rank test were applied where appropriate.
  
  
  RESULTS
  Biliary complications were observed in 227 cases (14.1%). Four hundred and seventeen (26%) transplantations were performed after the introduction of MELD-based donor organ allocation. Since then, 21% (n= 89) of the patients suffered from biliary complications, which are further categorized into anastomotic bile leaks [46% (n= 41)], anastomotic strictures [25% (n= 22)], cholangitis [8% (n= 7)] and non-anastomotic strictures [3% (n= 3)]. The remaining 18% (n= 16) were not further classified. After adjustment for all univariably significant variables, the recipient MELD-score at transplantation (P= 0.006; OR = 1.035; 95%CI: 1.010-1.060), the development of hepatic artery thrombosis post-operatively (P= 0.019; OR = 3.543; 95%CI: 1.233-10.178), as well as the donor creatinine prior to explantation (P= 0.010; OR = 1.003; 95%CI: 1.001-1.006) were revealed as independent risk factors for biliary complications. The compilation of these identified risk factors into a prognostic model was shown to have good prognostic abilities in the investigated cohort with an area under the receiver operating curve of 0.702.
  
  
  CONCLUSIONS
  The parallel occurrence of high recipient MELD and impaired donor kidney function should be avoided. Risk is especially increased when post-transplant hepatic artery thrombosis occurs.
authors.affiliation: Alexander Kaltenborn, André Gutcke, Department of Trauma and Orthopedic Surgery, Federal Armed Forces Hospital Westerstede, 26655 Westerstede, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kaltenborn
authors.affiliation: Alexander Kaltenborn, André Gutcke, Department of Trauma and Orthopedic Surgery, Federal Armed Forces Hospital Westerstede, 26655 Westerstede, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Gutcke
authors.affiliation: Alexander Kaltenborn, André Gutcke, Department of Trauma and Orthopedic Surgery, Federal Armed Forces Hospital Westerstede, 26655 Westerstede, Germany.
authors.forename: Jill
authors.initials: J
authors.lastname: Gwiasda
authors.affiliation: Alexander Kaltenborn, André Gutcke, Department of Trauma and Orthopedic Surgery, Federal Armed Forces Hospital Westerstede, 26655 Westerstede, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
authors.affiliation: Alexander Kaltenborn, André Gutcke, Department of Trauma and Orthopedic Surgery, Federal Armed Forces Hospital Westerstede, 26655 Westerstede, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Schrem
keywords: Biliary complications; Liver transplantation; Multivariable analyses; Prognostic model; Risk factors