Introduction: Biliary complications (BC) are the mos common reason for morbidity and mortality after liver transplantation (LT). Although previous studies reported 50% mortality and 23-30%morbidity rates, advancements in surgical technique, immunosuppression and organ preservation enabled to decrease these rates to 5-32% for morbidity and 19% for mortality. In this bulletin we present BC after LT in our institution.
Materials and Methods: Between 1997 and 2013 490 LT in 484 patients were performed. Mean age was 43.5, 336(69.4%) patients were male and 148(30.6%) were female. The most common etiology of end-stage liver disease was Hepatitis B and D. Bilio-biliary, bilio-enteric and combined bilio-biliary/bilio-enteric anastomoses were performed in 307(62.6%), 180(36.7%) and 3(0.7%) patients.
Results: Thirty (6.1%) patients had BC, 25(83.3%) were male and 5(16.7%) were female. Living donor transplantation was performed in 17 (56.7%) patients and cadaveric LT was performed in 13(43.3%) patients. Anastomoses were bilio-biliary in 24(80%) patients, bilio-enteric in 5(16.7%) and combined in 1(3%) patients. Indcation of the LT was Hepatitis B and D in all patients. Biliary complications were anastomotic stricture in 10 (33.3%) patients, bile leakage in 7(23.3%) patients, non-anastomotic stricture in 6(20%) patients, minimal dilatation in biliary tract in 6(20%) patients and bile stone in 1(3.3%) patient. Immunosuppression was achieved with calcineurin inhibitors based medication in all patients. Eleven (36.7%) patients had cholangitis at the time of diagnosis. Magnetic resonance cholangiopancreatography (MRCP), percutaneous cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) were diagnostic tests. In treatment, PTC and ERCP were used. Mortality was seen in 6 (20%) patients (5 biliary sepsis, 1 chronic rejection).
Conclusions: Biliary complications can be minimized with appropriate surgical technique and close postoperative follow-up. Most of the patients can be treated with interventional methods.
Volume : 11
Issue : 6
Pages : 48
Dokuz Eylül University Department of General Surgery, Hepatopancreatobiliary and Liver Transplantation Unit1, Department of Internal Medicine, Gastroenterology Unit2, Liver Transplantation Policlinic3