Management of biliary complications after liver transplantation

• Published in: The American journal of surgery Vol. 163; no. 5; pp. 519 - 524
• Main Authors: Lopez, Richard R., Benner, Kent G., Ivancev, Krassi, Keeffe, Emmet B., Deveney, Clifford W., Pinson, C.Wright
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.05.1992; Elsevier; Elsevier Limited
• Subjects: Bile; Bile ducts; Biliary tract; Biliary Tract Diseases - diagnostic imaging; Biliary Tract Diseases - etiology; Biliary Tract Diseases - therapy; Biological and medical sciences; Cholangiography; Choledochostomy - adverse effects; Complications; Dyskinesia; Hemorrhage; Humans; Implants; Liver; Liver transplantation; Liver Transplantation - adverse effects; Liver transplants; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Stricture; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Transplantation; Transplants; Transplants & implants
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/0002-9610(92)90401-C

Biliary tract complications after liver transplantation are common, and the evaluation of newer treatment options compared with standard surgical treatment is important. In 62 liver transplants performed in 55 adult patients, the biliary tract was reconstructed with choledochocholedochostomy (CC) in 52 (84%) and Roux-en-Y choledochojejunostomy (RYCJ) in 10 (16%). Seventeen biliary tract complications occurred in 16 patients (29%). The incidence of complications was the same after CC and RYCJ. Eight complications (47%) occurred within the first month and nine (53%) thereafter. Only 6 of 17 (35%) biliary tract complications required operation. One patient died of a biliary tract complication. No other allografts were lost due to biliary tract complications. Four patients transplanted at other centers were also treated, for a total of 21 biliary tract complications. Overall, there were nine bile leaks, eight bile duct strictures, two Roux loop hemorrhages, one choledocholithiasis, and one ampullary dyskinesia. Temporary or permanent stents were used successfully in seven of eight strictures. Five bile leaks were managed without operation. Nonsurgical management is appropriate for a selected majority of patients with late bile leaks, biliary tract strictures, or choledocholithiasis after liver transplantation.