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[Biliary complications following early hepatic arterial insufficiency in liver transplantation]
Shu-sen Zheng1, Xiao Xu, Ting-bo Liang
1Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, College of Medicine, Key Laboratory of Combined Multi-Organ Transplantation, Zhejiang University, Hangzhou 310003, China.
Objective:
To explore the clinical feature and treatment efficiency of patients with early hepatic arterial insufficiency (HAI) and biliary complications (BC) following liver transplantation (LT).
Methods:
The clinical data of 240 patients receiving LT from February 1999 to February 2004 were analyzed retrospectively. End-to-end choledococholocostomy was applied to 236 patients as the major biliary reconstructive method. Hemodynamic monitoring of the hepatic artery was performed to discover HAT, including hepatic arterial thrombosis (HAT) or hepatic arterial stenosis (HAS) in the first 3 months after transplantation.
Results:
In HAI Group, 7 cases of stricture of biliary tract and 4 cases of biliary leakage occurred; and 6 cases underwent endoscopic and/or intervention treatment, 4 cases underwent repair of anastomotic stoma and biliary drainage, 1 case underwent medication. Eight patients died and 3 were cured. A total of 32 patients (13.3%) developed biliary complications (BCs), Eleven of the 32 patients with BCs, biliary stricture in 8 cases and biliary leakage in 3 cases, had early HAI (HAI Group) with an incidence of 4.6% for BC with background of HAI (11/236). Another 21 patients with BCs (21/236, 8.7%) did not showed background of HAI (non-HAI Group). Preoperative serum total bilirubin levels were 373.3 +/- 93.9 micromol/L in HAI Group and 110.8 +/- 45.0 micromol/L in non-HAI Group (P = 0.008). Three cases with HAT underwent emergency thrombectomy then the hepatic arterial flow turned to normal. Two cases with HAS received short-term anticoagulant therapy. Recipients with BC underwent radiological and/or endoscopic interventional treatment (n = 6), surgical repair of leak site and biliary drainage (n = 4), and ordinary medication (n = 1). The 1 and 3-year survival rates of HAI Group were 54.6% and 16.4% respectively; both significantly lower than those of non-HAI Group (66.3% and 61.2%, both P = 0.042).
Conclusion:
The recipients with BC following early HAI are associated with poor outcome. The monitoring protocol of hepatic hemodynamics by color dopplar ultrasonography should be enhanced, which contributes to urgent revascularization or recovery of hepatic hemodynamics. Interventional therapies should be immediately applied and transferred to surgical treatment or even retransplantation when necessary for patients with BC following early HAI.
