Biliary tract complications following 52 consecutive orthotopic liver transplants

Biliary tract complications were analysed after 52 consecutive orthotopic liver transplants performed in 51 patients between September 1996 and April 1997. Reconstruction of the bile duct consisted of end-to-end choledochocholedochostomy without a T-tube (CC), (n = 40), and Roux-end Y choledochojejunostomy (CDJ) (n = 12)--six for children transplants, four for sclerosing cholangitis, one for cryptogenic cirrhosis and in one retransplantation. There was no intraoperative mortality. Biliary complications occurred in six liver transplants (11.55%). Early biliary complications (up to 3 months after operation) consisted of four bile leaks, for which ultrasonographically guided drainage was effective in one, endoscopic procedures in two and surgical repair in one case. Late biliary complications (3 month-onwards) consisted of one anastomotic stricture--reoperation was required, and one ampullary dysfunction, where endoscopic sphincterotomy was performed.

Biliary complications are rather frequent after orthotropic liver transplantation (OLT) and can be treated effectively and do not cause excessive mortality. T-tubes and stents are not to be recommended.