Pathogenetic Multiplicity And Prognosis-related Investigation Of Biliary Complication Following Liver Transplantation

PartIPathogenetic multiplicity of biliary complication following liver transplantationObjectiveTo explore the risk factors contributing to the development of biliary complication(BC) following liver transplantation(LT) and to settle a foundation for BC-incidence prognostic system.MethodsThe clinical data of 374 patients received LT from Feb. 1999 to Jan. 2005 were collected intergritly. Preoperative variables included sex, age, primary disease, serum biochemic function, ABO-blood type, Model for End-stage Liver Disease (MELD) score and Child-Turcotte-Pugh (CTP) grade. Operative variables included LT style, biliary reconstruction type and graft blood supply order. Postoperative variables included hepatic arterial insufficiency(HAI), cytomegalovirus(CMV) infection and acute rejection(AR). Simultaneously we monitored the process of the biliary tree intimately with MRCP or ERCP and some clinical manifestation. A retrospective analysis was performed to reveal the influence on the BC incidence of factors above-mentioned.Results50(13.4%, BC group) recipients were developed BC, including 45 strictures, 6 leakages and 3 stones, other 324 recipient were not found BC(non-BC group). By means of univariate analysis, risk factors associated with BC were biliary reconstruction techmque(P=0.006), HAI(P<0.001), AR(P<0.001) and CMV infection(P = 0.017). For non-anastomotic BC, not only HAI(P<0.001), AR(P<0.001) and CMV infection(P=0.001) but placement of "T" tube(P=0.011), could all increased the incidence, the opening order of portal vein and hepatic artery could be a potential factor. For anastomotic BC, AR(P= 0.038) was the only risk factor. Stepwise logistic regression analysis demonstrated that HAI, AR and CMV infection were independent risk factors predicting BC. Furthermore, placement of "T" tube was also an independent factor for non-anastomotic BC besides HAI, AR and CMV infection. Patient survival rates at 1, 3, and 5 years were 67.9%, 38.2% and 19.1 %, respectively in BC group, significantly lower than 86.1%, 82.8% and 81.0% in non-BC group(Log-rank test, P=0.02).ConclusionBC remains a major problem posttransplantation. Modification of the biliary reconstruction technique including abandon of "T" tube could reduce BC incidence, HAI, AR and CMV infection were independent risk factors for BC, especially for non-anastomotic BC. non-anastomotic BC is a key factor causing retransplantation, The recipients with BC are associated with poor outcome.Part II Biliary complications following early hepatic arterial insufficiencyin liver transplantationObjectiveTo explore the clinical feature and treatment efficiency of patients with early hepatic arterial insufficiency(HAI) and biliary complications(BC) following liver transplantation(LT). MethodsThe clinical data of 240 patients received LT from Feb. 1999 to Jan.2005 were analyzed retrospectively. End-to-end choledococholocostomy was applied to 370 patients as the major biliary reconstructive method. Early HAI was diagnosed as an event of hepatic arterial thrombosis (HAT) or hepatic arterial stenosis (HAS) in the first 3 months posttransplantation. ResultsA total of 50 patients developed biliary complications, of these, 14 (4.6%) had early HAI (HAI group) including 3 HAT and 11 HAS, and developed BC including biliary stricture in 11 cases and biliary leakage in 3 cases. Other 36 recipients developed BC without the background of HAI (non-HAI group). Preoperative serum total bilirubin levels are 311.8±300.0umol/L in HAI group and 130.1 ± 177.5umol/L in non-HAI group. Three cases with HAT underwent emergency thrombectomy then hepatic arterial flow turned to be normal. Two cases with HAS received short-term anticoagulant therapy. Recipients with BC underwent radiological and/or endoscopic interventional treatment (n=7), surgical repair of leak site and biliary drainage (n=6), ordinary medication (n=l) and retransplantation(n=2). Recipient survival rates at 1 and 3-year in HAI group were 63.5% and 15.9%, significantly lower than 73.2% and 49.3% in non-HAI group (P=0.042). ConclusionThe...