Biliary complications following liver transplantation: a 13-years single-center experience
Maria Florencia Fernandez1, Dario Teran1, Leonardo Montes1, Pablo Farinelli1, Victoria Atencio2, Valeria Descalzi2, Raul Garces Muller3, Pablo Barros Schelotto1, Gabriel Gondolesi1.
1HPB and complex gastrointestinal surgery and abdominal organ transplant, Hospital Universitario Fundacion Favaloro, Caba, Argentina; 2Hepatology, Hospital ospital Universitario Fundacion Favaloro, Caba, Argentina; 3Gastroenterology, Hospital ospital ospital Universitario Fundacion Favaloro, Caba, Argentina
Introduction: Orthotopic liver transplantation (LT) is the chosen treatment for end-stage liver disease. Despite the advances in the surgical techniques, biliary tract complications are the most common problems seen after transplantation with an incidence range of 10-25%. We aim to describe the incidence of biliary complications at our center.
Patients and Methods: Retrospective study of patients who suffered from biliary complications after LT between September 2009 and February 2022 in a single center. Demographic characteristics: cause of liver failure, MELD score, time on waiting list (WL), DRI, national, regional or local procurement; preservation solution, warm ischemia time (WIT), cold ischemia time (CIT), chosen treatment and success rate (SR), patient and graft survival. Biliary complications were divided into 2 groups, according to the moment of appearance: early complication (EC) when they happened within the first 30 post-operative days and delayed complication (DC) when they ocurred afterwards. All analyses were performed using IBM SPSS v25.0.
Results: From a total of 549 LT that were performed during the period of study, 90 (16%) had biliary tract complications. Among them, 78 were adult recipients, with a mean age of 48 years old (DS 21). Sixty-four transplants (71%) were performed due to cirrhosis, caused mainly due to viral disease (25, 39%) and alcohol (18, 28%). Sixty-nine (90%) were performed with whole liver and 8 (10%) with partial grafts (7 right and 1 left lobe). The most frequent biliary complication in the EC and DC group was the biliary anastomotic stenosis, with 21 (60%) and 33 cases (78%), respectively. Eighteen patients (23%) lost their graft (7 EC and 11 DC). Table 1 shows biliary complications according to time of appearance and initial treatment chosen.
Among the pediatric patients, the mean age was 3 years old (range 1-10) and the main cause for transplant was biliary atresia (5, 42%). Nine patients suffered of biliary leak (8 within the EC groups and 1 DC) and 3 of biliary anastomotic stenosis (2 EC and 1 DC). Three patients (25%) lost their grafts (all from EC). Table 2 shows biliary complications according to time of appearance and initial treatment chosen.
Discussion: Biliary complications remain a major cause of morbidity, dysfunction, and mortality in liver transplant recipients and continue to be a challenging aspect in the management of such patients. With appropriate management, however, there impact on graft and overall survival could be minimized.
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