T-tube Systematic Use in the Biliary Anastomosis: Comparison of Two Consecutive Series of Liver Transplantation.

OBJECTIVES: The authors sought to check the frequency of biliary complications with the use of a T-tube. In 2012, throughout the year, it was carried out systematically in all liver transplantations regardless of the characteristics of the bile duct. Despite the long experience, biliary complications remain a common cause of postoperative morbidity and mortality. MATERIAL AND METHODS: In this study we compared complications in 23 consecutive transplantation cases using T-tube biliary anastomosis during the year 2012 with 23 consecutive transplantation cases without T-tube during the year 2013. We evaluated postoperative complications and long-term outcomes (for 2 years to 3 years). RESULTS: Of the 23 patients with anastomosis with a T-tube, 2 patients (8.69%) had biliary stricture that required prosthesis by endoscopic retrograde cholangiopancreatography, 1 of them (4.34%) was operated by incorrect placement of the T-tube, and in 4 patients (17.39%) bile leakage (endoscopic retrograde cholangiopancreatography prostheses in 3 cases and hepaticojejunostomy in 1). During follow-up at 3 years, only 2 patients had minimal bile duct dilatation without clinical relevance. In the patients who underwent transplantation without a T-tube, 18 (78.26%) had no complications, 3 (13.04%) showed stenosis (prosthesis placement), and 2 (8.69%) had bile leakage (hepaticojejunostomy and prosthesis). During follow-up at 2 years to 3 years, no patient had biliary dilatation or alteration of cholestatic parameters. In the comparative study of both groups we found no statistically significant differences. CONCLUSIONS: We have not seen an improvement in complications with the use of T-tube (69.56% vs. 78.23%) that encourage us to work systematically, although the small number of cases does not allow statistically significant conclusions.

Collateral Development in Thrombosis of the Hepatic Artery After Transplantation.

OBJECTIVES: The authors sought to identify strictures or hepatic artery obstruction with posterior collateral transformation in our series of liver transplantation, treatment, and evolution. The thrombosis or severe hepatic artery stenosis sometimes presents a compensation mechanism, the collateral transformation of the artery. MATERIAL AND METHODS: From April 2002 to December 2011 we collected 18 cases of collateral transformation. We analyzed data regarding the transplantation, diagnosis, treatment, clinical evolution, liver function, and Doppler-ultrasound. RESULTS: The main indication was alcoholic cirrhosis, followed by hepatocellular carcinoma - hepatitis C virus. The mean cold ischemia time was 292.2 minutes mean hot ischemia was 48.8. The anastomosis was performed on the gastroduodenal-splenic patch donor in 14 cases, the celiac trunk in 2 cases, and on grafts to the aorta in another 2. Doppler ultrasound showed 8 cases without complications, 8 with low flows, and 2 cases with alterations of the right hepatic artery. Computed tomographic (CT) angiography was performed in patients with impaired eco-Doppler and found 4 obstructions, 2 cases with kinking, 1 stenosis, and 3 normal cases. Three patients with low flows were re-operated and another re-transplanted. After diagnosis of collateral transformation, all were treated with antiplatelet agents. Two cases of angioplasty were associated. The collaterals were diagnosed 1 month to 44.8 months after transplantation. Five patients died. In the latest data, 10 patients do not have analytical alteration. The Doppler ultrasound shows 7 cases being normal and 6 with flow but low resistances. CONCLUSIONS: In our series, all patients with collateral transformation, except one who was transplanted, maintain good liver function with permeable vessels.