Biliary Complications in Relation to the Technique of Biliary Reconstruction in Adult Liver Transplant Recipients

[Guest guest]

doi:10.1016/j.transproceed.2007.09.017 Copyright © 2007 Elsevier Inc. All rights reserved.

Liver transplantation

A. Alsharabia, , , K. Zieniewicza, B. Michałowicza, W. Patkowskia, P. Nyckowskia, T. Wróblewskia, I. Grzelaka, R. Paluszkiewicza, P. Hevelkea, P. Remiszewskia, B. Cieślaka, O. Kornasiewicza, M. Kotulskia, A. Skwareka, M. Urbana, J. Sańko-Resmerb and M. Krawczyka aDepartment of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, PolandbDepartment of Immunology, Transplant Medicine and Internat Diseases, Medical University of Warsaw, Warsaw, Poland. Available online 20 November 2007.

Abstract

Biliary complications are known as a weak point of liver transplantation. Their occurence can be related to the practice of draining the biliary anastomosis performed at the time of transplantation. At our institution, routine of anastomotic biliary drainage was abandoned in June 2004. Aim

We sought to assess the occurence and character of biliary complications following orthotopic liver transplantation in relation to the technique of anastomosis. Materials and Methods

In two groups of transplantees: last 100 transplantations with biliary drainage (48 females and 52 males aged 17 to 64 years) and last 100 transplantations without drainage (52 females and 48 males aged 18 to 67 years). The results of treatment were compared, for biliary complications and their influence on further management. In both groups, the main indications for transplantation were various types of cirrhosis as well as cholestatic diseases. In most cases (167) we performed a cholangiojejunal Roux-en-Y (CBD) end-to-end anastomosis, less commonly (33 cases) hepaticojejunal anstomoses. Results

In the first group, biliary complications (bile leak at the site of drainage, bile leak after T-tube removal, CBD strictures) requiring surgical or endoscopic intervention, occurred in 17% recipients. In one case, the biliary complication resulted in retransplantation. In the second group, biliary complications occured in 11% patients. None of them caused organ loss. Conclusion

Abandoning drainage of the biliary anastomosis has reduced the occurrence of early biliary complications after orthotopic liver transplantation.

Address reprint requests to Abdulsalam Alsharabi, MD, PhD, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland. Banacha 1A Str. 02-097 Warsaw, Poland.

Transplantation Proceedings Volume 39, Issue 9, November 2007, Pages 2785-2787