Diagnosis and treatment of biliary complications after liver transplantation: analysis of 258 cases / 南方医科大学学报

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the approaches to diagnosis, treatment and prevention of the biliary complications after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>The clinical data were collected from 258 adult patients receiving orthotopic liver transplantation between August, 2004 and December, 2011, among whom 56 patients with biliary complications were identified to analyze the diagnosis and treatment of the complications.</p><p><b>RESULTS</b>The incidence of biliary complication was 22.13% in the 258 recipients of secondary liver transplantation. Of the 56 patients with biliary complication, 32 (57.14%) had biliary stricture and 24 (42.86%) had bile leakage; 36 (64.29%) patients presented a simple type of biliary complication and 20 (35.71%) had a composite type, including bile leakage, biliary obstruction, biliary calculi, biliary tract infections, biliary sludge formation, and biliary tract bleeding. Thirty-one patients (55.36%) underwent routine endoscopic retrograde cholangiopancreato- graphy (ERCP), percutaneous transhepatic cholangiography (PTC) and other endoscopic or interventional treatments, and 23 (74.19%) were cured or showed improvement, while 3 died due to multiple organ dysfunction syndrome (MODS).</p><p><b>CONCLUSION</b>Appropriate surgical approaches and skills in bile duct anastomosis are crucial to reduce the incidence of biliary complications following liver transplantation. Non-surgical treatment (including ERCP) is the primary option, followed by surgical bile duct exploration, for the management of biliary complications; liver retransplantation is the most effective life-saving means for patients with liver graft non-function. But still, prevention of biliary complications is of pivotal importance to improve the outcome of liver transplantation.</p>