Analysis and management of the biliary complications after liver transplantations.
- Author:
Chun-Hui YUAN
1
;
Dian-Rong XIU
;
Bin JIANG
;
Zhi-Fei LI
;
Lei LI
;
Ming TAO
;
Shi-Bing SONG
;
Tong-Lin ZHANG
Author Information
- Publication Type:Journal Article
- MeSH: Adolescent; Adult; Aged; Biliary Fistula; therapy; Biliary Tract Diseases; epidemiology; therapy; Cholangiopancreatography, Endoscopic Retrograde; Female; Humans; Liver Transplantation; Logistic Models; Male; Middle Aged; Postoperative Complications; epidemiology; therapy; Retrospective Studies; Risk Factors; Young Adult
- From: Chinese Journal of Surgery 2013;51(6):499-503
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVETo discuss the relevant factors of biliary complications after liver transplantation and to investigate the value of comprehensive management for the complications.
METHODSThe data of 366 patients undergoing liver transplantation from October 2000 to March 2012 was analyzed retrospectively, and the risk factors were analyzed by univariate analysis and Stepwise Logistic regression. The cases with biliary leak were administered thorough drainage. The cases with anastomotic biliary stricture were administered sacculus dilatation through percutaneous transhepatic cholangiography (PTC) and endoscopicretrograde cholangiopancreatography (ERCP). If necessary, some cases were placed biliary tract brackets. The patients with nonanastomotic biliary stricture were treated with PTC plus choledochoscope.
RESULTSAll the 366 patients were followed up for 58.5 (10 to 129) months. Biliary complications after liver transplantation were diagnosed in 42 cases among these patients. The incidence for biliary complications was 11.5%. The univariate analysis and multivariate Logistic regression analysis showed that the second warm ischemia period and the blood loss and the damage of blood supply and the diameter of biliary anastmosis were significantly associated with biliary complications after liver transplantations (Wald = 9.474 to 17.208, P < 0.05). Twelve cases with biliary leak were cured through abdominal and nasobiliary drainage. Twenty-two cases with anastomotic biliary stricture were administered sacculus dilatation through ERCP or PTC and were cured, including 6 cases were placed biliary tract brackets. Among 8 cases with nonanastomotic biliary stricture, 6 cases were cured through PTC associating with choledochoscope. One case was treated second liver transplantation and another case got worse.
CONCLUSIONSIschemic injury and the diameter of anastmosis are risk factors for biliary complications after liver transplantations. The interventional management of biliary stricture and bile leakage after liver transplantation is safe and effective.
