An Analysis Of Risk Factors And Treatment For Biliary Complication After Adult Orthotopic Liver Transplantation

Objective:This study evaluates the biliary complication risk factors,clinical character and the treatment of biliary complications after adult orthotopic liver transplantation.Methods:we performed a retrospective review of 102 orthotopic liver transplants performed between May in 2006 and Febrary in 2015 in The First People s Hospital Of Kunming. Collecting the clinical related data,16 independent variables were analyzed by univariate analysis and logistic regression to screen out the risk factor. The occurrence of biliary complications was confirmed by abdominal cavity drainage tubes,B ultrasonography, MRCP and ERCP in these patients with a high index of suspicion.The incidence、clinical character and prognosis for postoperative biliary complications were recorded. The initial non-surgical treatment includes endoscopic retrograde cholangiopancreatography、percutaneoustranshepatic cholangiography、 choledochoscopic examination and making an adjustment or replacement of drainage tube,which should be treated according to the different situations. Surgery can be applied to those that minimally invasive treatment failure or with poor results.Results:The median occurring time of biliary complication was 36.5 months (1～106 months) after live transplantation. Biliary complications after liver transplantation were diagnosed in 19 cases among these patients, including five cases of bile leakage, six cases of anastomotic strictures, four cases of nonanastomotic strictures, one case of T tube prolapse, one case of left hepatic duct stones, one case of sludge, one case of infection of biliary tract, The incidence for biliary complications was 18.6%.The univariate analysis and multivariate logistic regression analysis revealed that the second warm ischemia period and the bile duct restruction with T tube were associated with biliary complications after liver transplantation.Among six cases with anastomotic biliary stricture,one case was cured by placed biliary stents, one case was cured by operation and further endoscopic approaches,another two were cured by endoscopic nasobiliary drainage. Among four cases with nonanastomotic biliary stricture,one case was cured through balloon dilation of strictures associating with EST and endoscopic nasobiliary drainage,one case was cured by operation, one case was cured by adjustment of T tube and inserting bracing tube. Among five cases with biliary leak,one case was cured by placing biliary stent,one case was cured by abdominal drainage,one case was cured by operation, one case was cured by adjustment of T tube.One case with biliary tract infection was cured by percutaneous transhepatic biliary drainage.Conclusion:The second warm ischemia period and the bile duct restruction with T tube are risk factors for biliary complications after liver transplantation,which could be control to reduce the biliary complications occurrence.Biliary stricture and bile leakage after liver transplantation respond well to the minimally invasive treatment,m aking it the preferred safe and very effective approach whenever feasible,otherwise, operation is the last effective resort.