Tim R. Glowka, Caroline Karlstetter, Tobias J. Weismüller, Tim O. Vilz, Christian P. Strassburg, Jörg C. Kalff, Steffen Manekeller
Department of Surgery, University Hospital Bonn, Bonn, Germany
Ann Transplant 2021; 26:e928907
Available online: 2021-02-17
Biliary complications are common causes of morbidity and mortality after liver transplantation.
MATERIAL AND METHODS: From 2013 to 2018, 102 whole-organ liver transplantations were conducted in our department. Patients were closely monitored for biliary complication development. In all suspected cases, patients underwent either endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangial drainage. Patients’ demographic characteristics, preexisting conditions, and perioperative characteristics, as well as morbidity and mortality, were analyzed. Risk factors for 1-year survival were calculated.
RESULTS: Of the 102 patients, 43 (42%) experienced biliary complications. In comparison with patients without biliary complications, patients with biliary complications exhibited the following risk factors: underlying liver disease (viral hepatitis; P=0.009), blood group A (P=0.005), and previous abdominal surgery (P=0.037). Neither perioperative characteristics, especially duration of cold ischemia (P=0.86), nor postoperative course differed between patients with and without biliary complications. Risk factors for mortality within 1 year were cirrhosis caused by entities other than viral hepatitis (P=0.017), cardiac comorbidities (P=0.019), re-transplantation (P=0.032), and reduced organ weight (P=0.002). Biliary complications, postoperative hemorrhage, primary nonfunction, and repeated surgery worsened outcome; moreover, serum bilirubin trough in the first 30 days after transplantation might be prognostic for mortality (P=0.043).
CONCLUSIONS: Biliary complications adversely affect outcome after liver transplantation. Neither frequency nor outcome of biliary complications was improved by intensified endoscopic evaluation. Patients on the waiting list for liver transplants should also be closely monitored for cardiac comorbidities.
Keywords: Anastomotic Leak, Biliary Fistula, Biliary Tract, Endoscopy, Liver Cirrhosis, Liver Transplantation