Biliary complications after liver transplantation

Background: The purpose of this study was to report the morbidity and mortality of patients who undergo liver transplantation with or without T-tube implantation after choledochocholedochostomy as well as to discuss management of bile duct complications. Patients and Methods: From August 2001 to November 2005, a retrospective review of 94 orthotopic liver transplantations was conducted. 43 patients underwent choledochocholedochostomy with T-tube implantation (group A); 45 patients underwent choledochocholedochostomy without T-tube implantation (group B). Three patients who underwent living donor liver transplantation and 3 choledochojejunostomy patients were excluded. Results: Between the two groups, there were no significant differences in clinical characteristics, including sex, age, indication of liver transplantation (hepatitis B virus, hepatitis C virus, alcoholic liver cirrhosis, or hepatocellular carcinoma), Child-Pugh classification, preoperative laboratory data, and operative, macroscopic and microscopic findings. Additionally, there were no significant differences in bile duct complications and overall survival rate. Of these 88 patients with orthotopic liver transplantation, 11 (12.5%) developed biliary complications (10 male, 1 female). Seven patients had anastomostic stricture and underwent endoscopic retrograde cholangiopancreatography (ERCP) with stent implantation. In 5 of these patients ERCP and stent implantation failed, and surgery was done with successful results. Conclusions: Whether or not stent implantation is done during choledochocholedochostomy after OLT has no impact on the frequency of biliary complications or survival time. The biliary complications after liver transplantation can be managed by ERCP with stent implantation. If ERCP fails, surgical intervention should be considered immediately. © 2006 S. Karger GmbH.