Biliary complications after liver transplantation: An 18-year single-center experience

Te I. Chang, Ming Chi Ho, Yao Ming Wu, Po Huang Lee, Rey Heng Hu

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background/Purpose: Biliary complications remain a major weakness of liver transplantation. The purpose of this retrospective study was to determine risk factors associated with biliary complications after liver transplantation, and how they were managed. Methods: From October 1989 to December 2007, we collected all variables of interest in 253 consecutive liver transplant recipients at the National Taiwan University Hospital. Risk factors and the outcome of different treatments of the biliary complications were analyzed. Results: Forty-three (17.0%) of the 253 liver transplant patients developed biliary complications. Bile leakage and biliary stricture rate was 7.9% and 6.7%, respectively. By univariate analysis, risk factors associated with bile leakage were older age, cadaveric liver donation, and use of a T-tube. The only protecting factor against bile leakage was the use of a straight intrahepatic stent. Risk factors associated with biliary stricture were rejection and male sex. Multivariate analysis demonstrated that T-tube [odds ratio (OR) = 3.45] and older age group (OR=7.98) were the only independent risk factors for bile leakage, whereas graft rejection (OR=4.89) and male sex (OR=5.56) were the only independent risk factors for biliary stricture. Percutaneous transhepatic cholangiography drainage (37.2%) or computed-tomography-guided drainage (27.9%) was the most frequent initial treatment. Biliary event-free rate after initial treatment was 67.6% and 66.7% in the non-surgical and surgical group, respectively. Conclusion: The risk factors for bile leakage and biliary stricture were different due to different pathogenesis. Straight biliary stent in our series showed a protective effect against bile leakage. Non-surgical management can be a highly successful initial treatment, and surgery should be reserved for patients who have failed conservative treatment.

Original languageEnglish
Pages (from-to)183-189
Number of pages7
JournalJournal of the Formosan Medical Association = Taiwan yi zhi
Volume110
Issue number3
DOIs
Publication statusPublished - Mar 2011
Externally publishedYes

Fingerprint

Liver Transplantation
Bile
Pathologic Constriction
Odds Ratio
Stents
Drainage
Liver
Cholangiography
Sex Ratio
Graft Rejection
Taiwan
Therapeutics
Multivariate Analysis
Retrospective Studies
Age Groups
Tomography
Transplants

Keywords

  • Bile leakage
  • Biliary stricture
  • Graft rejection
  • Liver transplantation
  • Percutaneous transhepatic cholangiography drainage

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Biliary complications after liver transplantation : An 18-year single-center experience. / Chang, Te I.; Ho, Ming Chi; Wu, Yao Ming; Lee, Po Huang; Hu, Rey Heng.

In: Journal of the Formosan Medical Association = Taiwan yi zhi, Vol. 110, No. 3, 03.2011, p. 183-189.

Research output: Contribution to journalArticle

Chang, Te I. ; Ho, Ming Chi ; Wu, Yao Ming ; Lee, Po Huang ; Hu, Rey Heng. / Biliary complications after liver transplantation : An 18-year single-center experience. In: Journal of the Formosan Medical Association = Taiwan yi zhi. 2011 ; Vol. 110, No. 3. pp. 183-189.
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abstract = "Background/Purpose: Biliary complications remain a major weakness of liver transplantation. The purpose of this retrospective study was to determine risk factors associated with biliary complications after liver transplantation, and how they were managed. Methods: From October 1989 to December 2007, we collected all variables of interest in 253 consecutive liver transplant recipients at the National Taiwan University Hospital. Risk factors and the outcome of different treatments of the biliary complications were analyzed. Results: Forty-three (17.0{\%}) of the 253 liver transplant patients developed biliary complications. Bile leakage and biliary stricture rate was 7.9{\%} and 6.7{\%}, respectively. By univariate analysis, risk factors associated with bile leakage were older age, cadaveric liver donation, and use of a T-tube. The only protecting factor against bile leakage was the use of a straight intrahepatic stent. Risk factors associated with biliary stricture were rejection and male sex. Multivariate analysis demonstrated that T-tube [odds ratio (OR) = 3.45] and older age group (OR=7.98) were the only independent risk factors for bile leakage, whereas graft rejection (OR=4.89) and male sex (OR=5.56) were the only independent risk factors for biliary stricture. Percutaneous transhepatic cholangiography drainage (37.2{\%}) or computed-tomography-guided drainage (27.9{\%}) was the most frequent initial treatment. Biliary event-free rate after initial treatment was 67.6{\%} and 66.7{\%} in the non-surgical and surgical group, respectively. Conclusion: The risk factors for bile leakage and biliary stricture were different due to different pathogenesis. Straight biliary stent in our series showed a protective effect against bile leakage. Non-surgical management can be a highly successful initial treatment, and surgery should be reserved for patients who have failed conservative treatment.",
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