Biliary Complications After Orthopic Liver Transplantation

Objective To study the cause , diagnosis , treament and prevention of biliary complications after liver transplantation . Methods fourteen recipients who had received liver transplantation between June 2000 and April 2005 were retrospectively reviewed . Results Three cases developed biliary complications. They all suffered from benign telophase hepatic diseases and were given piggyback liver transplantations. End-to-end biliary anastomosis with T-tube was used for biliary tract reconstruction. Hepatic artery thrombosis (HAT) was not found. Their common clinical performance is slowly-progressively obstructive jaundice in the long-dated postoperation. Biliary strictures accompanied with elevated bilirubin and (or) aminotransferase were confirmed by T-tube cholangiotography , magetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). They all survived by interventional therapy. In case one, cold ischemia time (CIT) is 11h30min and hepatic artery ischemia(HAI) time is 60min. Two weeks after the operation acute rejection occurred once. Biliary anastomosis stricture was confirmed by T-tube Cholangiotography and MRCP two months after the operantion, and was cured by 3 times of treatment by stricture balloon dilation and stent. This patient has lived a normal life for twenty seven months without any clinical symptom. In case two, CIT is 12h30min. Graft cytomegalovirus infection and acute rejection occurred once after the operation. Stricture of biliary anastomosis and hepatic duct confluent was confirmed by MRCP and ERCP ten months after the operation, Stricture remained and intrahepatic biliary calculi was found after two times of treatment by stricture dilation and stent in ten months. The symptoms turned better dramatically after the third treatment by sludges extraction and stricture dilation and stent. This patient has survived twenty one months. In case three, CIT was 12h and HAI time was 80min. Biliary anastomosis stricture was confirmed by T-tube Cholangiotography and ERCP two months after the operantion, and was cured with 3 times of treatment by stricture balloon dilation and stent. Conclusion Warm ischemia,cold ischemia and hepatic artery ischemia are important causes of biliary complications after orthotopic liver transplantation. Acute rejection and graft cytomegalovirus infection can both lead to biliary complications. Biliary tract injury will be aggravated and the possibility of biliary complications will increase when two or more causes exist at the same time (such as ischemic injury combined with acute rejection and/or graft cytomegalovirus infection. Biliary anastomosis stricture and biliary sectional stricture are common types ofbiliary complications among our cases, and their specific clinical performance is slowly-progressively obstructive jaundice in the long-dated postoperation. The application or a combined application of T-tube Cholangiotography or ERCP or MRCP if necessary enables accurate depiction of the bile tree and detection of biliary complications. Endoscopic therapy by stricture dilation and stent is usually successful in patients with anastomosis or hepatic common bile duct stricture after orthotopic liver transplantation. Biliary complications are important factors determining postoperative survival. Their causes are complicated and results are severe. The management are difficult. So prevention is the most important. Furthermore, early diagnosis should be made and pertinent management should be taken according to different types of complications.