Biliary complications following liver transplantation in the model for end-stage liver disease era: Effect of donor, recipient, and technical factors

Abstract

Biliary complications remain a significant problem following liver transplantation in the Model for End-Stage Liver Disease (MELD) era. We hypothesized that donor, recipient, and technical variables may differentially affect anastomotic biliary complications in MELD era liver transplants. We reviewed 256 deceased donor liver transplants after the institution of MELD at our center and evaluated these variables' association with anastomotic biliary complications. The bile leak rate was 18%, and the stricture rate was 23%. Univariate analysis revealed that recipient age, MELD, donor age, and warm ischemia were risk factors for leak, whereas a Roux limb or stent was protective. A bile leak was a risk factor for anastomotic stricture, whereas use of histidine tryptophan ketoglutarate (HTK) versus University of Wisconsin (UW) solution was protective. Additionally, use of a transcystic tube/stent was also protective. Multivariate analysis showed that warm ischemia was the only independent risk factor for a leak, whereas development of a leak was the only independent risk factor for a stricture. HTK versus UW use and transcystic tube/stent use were the only independent protective factors against stricture. Use of an internal stent trended in the multivariate analysis toward being protective against leaks and strictures, but this was not quite statistically significant. This represents one of the first MELD era studies of deceased donor liver transplants evaluating factors affecting the incidence of anastomotic bile leaks and strictures. Donor, recipient, and technical factors appear to differentially affect the incidence of anastomotic biliary complications, with warm ischemia, use of HTK, and use of a stent emerging as the most important variables. Liver Transpl 14: 73-80, 2008.

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

“…The University of Michigan reviewed 256 OLTs performed after the institution of the Model for End-Stage Liver Disease and found that longer warm ischemic time was the only independent risk factor after multivariate analysis for the development of biliary leaks. 16 The presence of biliary casts was not evaluated in that study. Prolonged warm ischemic time has also been associated with irreversible bile duct damage and poorer outcomes in NHBD grafts.…”

Reoperative Complications after Primary Orthotopic Liver Transplantation: A Contemporary Single-Center Experience in the Post–Model for End-Stage Liver Disease Era

“…[11][12][13] Although many large series have reported the overall rates of postoperative graft nonfunction; vascular thromboses; and biliary, infectious, and hemorrhagic complications, 5,11,12,[14][15][16][17][18][19] neither the specific management nor the effects of these complications on graft and patient survival are described. This study represents the largest contemporary singlecenter experience to report the scope of reoperative complications after primary liver transplantation and their associations with graft and patient outcomes.…”

Interventional radiology procedures in adult patients who underwent liver transplantation

“…Biliary complications occur in 10%-40% of patients after LT [37][38][39][40] , with major incidence in patients with partial LT [41][42] . Complications include BSs, bile leakage (BL), biliary stones and bilomas.…”

“…BS is a common problem after LT with a reported incidence of 10%-35% [37][38][39][40] . Anastomotic BS is usually related to scar tissue and retraction at the suture site [41][42] .…”

“…Post-operative BL is a complication of LT that usually occurs within a few weeks from the transplant in 5%-20% of patients [37][38][39]53] . BL can arise from bile duct anastomosis of the resection margin in partial LT. Another possible site of leakage is the T-tube insertion in patients with choledocho-choledocho anastomosis.…”