Refractory anastomotic bile leaks after orthotopic liver transplantation are associated with hepatic artery disease

• Published in: Gastrointestinal endoscopy Vol. 85; no. 5; pp. 984 - 992
• Main Authors: DaVee, Tomas, MD, MSCI, Geevarghese, Sunil K., MD, MSCI, Slaughter, James C., DrPH, Yachimski, Patrick S., MD, MPH, FASGE
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017
• Subjects: Anastomosis, Surgical; Anastomotic Leak - epidemiology; Anastomotic Leak - surgery; Bile Ducts - surgery; Cholangiopancreatography, Endoscopic Retrograde; Computed Tomography Angiography; Constriction, Pathologic; Female; Gastroenterology and Hepatology; Hepatic Artery - diagnostic imaging; Humans; Liver Transplantation; Magnetic Resonance Angiography; Male; Middle Aged; Retrospective Studies; Ultrasonography, Doppler; Vascular Diseases - diagnostic imaging; Vascular Diseases - epidemiology; fully covered self-expanding metal stent; orthotopic liver transplant; IQR; interquartile range; OLT; FCSEMS
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2016.08.050

Background and Aims Anastomotic bile leaks are common after orthotopic liver transplant (OLT), and standard treatment consists of placement of a biliary endoprosthesis. The objectives of this study were to identify risk factors for refractory anastomotic bile leaks and to determine the morbidity associated with refractory bile leaks after OLT. Methods Consecutive adult patients who underwent ERCP for treatment of post-OLT biliary adverse events between 2009 and 2014 at a high-volume transplant center were retrospectively identified. A refractory leak was defined as a bile leak that persisted after placement of a plastic biliary endoprosthesis and required repeat endoscopic or surgical intervention. Results Forty-three subjects met study inclusion criteria. Median age was 57 years, and 36 (84%) subjects were men. Refractory bile leaks were diagnosed in 40% of subjects (17/43). Time-to-event analysis revealed an association between refractory bile leaks and the combined outcome of death, repeat transplant, or surgical biliary revision (hazard ratio, 3.78; 95% confidence interval, 1.25-11.45; P  = .01). Hepatic artery disease was more common with refractory compared with treatment-responsive bile leaks (53% vs 8%, P  = .001). Conclusions Refractory anastomotic bile leaks after liver transplantation are associated with decreased event-free survival. Hepatic artery disease is associated with refractory leaks. Large-scale prospective studies should be performed to define the optimal management of patients at risk for refractory bile leaks.