Biliary complications in 100 adult liver transplantations: a retrospective clinical study

Biliary complications were reviewed in 100 consecutive adult liver transplantations. Included in the study were 92 patients surviving for more than 1 month. In 86 transplantations biliobiliary anastomosis was performed with (n = 25) or without (n = 61) a T-tube. In six cases biliodigestive anastomosis (Roux-en-Y) was performed. Biliary stricture caused by hepatic arterial thrombosis was not included. Biliary complications were seen in 17 cases: seven anastomotic strictures, four T-tube-related leakages, four anastomotic leakages, one leakage of unknown origin and one late cholangitis. Nine were surgically treated (six strictures and three leakages). Patients with primary sclerosing cholangitis had the highest biliary complication rate (36%). Early anastomotic strictures were associated with a higher rate of major bacterial infections (P = 0.03) and CMV disease (P = 0.08) than those without biliary complications. Biliobiliary anastomosis with a T-tube was associated with more complications (28%) than anastomoses without a T-tube (13%). To date, total patient survival including all 100 transplantations was 71% (median follow-up 3.3 years). We conclude that biliary complications are rather common but they do not affect survival and can be treated. Biliary T-tubes can be omitted.