Biliary complications after liver transplantation: an 18-year single-center experience

Biliary complications remain a major weakness of liver transplantation. The purpose of this retrospective study was to determine risk factors associated with biliary complications after liver transplantation, and how they were managed.

From October 1989 to December 2007, we collected all variables of interest in 253 consecutive liver transplant recipients at the National Taiwan University Hospital. Risk factors and the outcome of different treatments of the biliary complications were analyzed.

Forty-three (17.0%) of the 253 liver transplant patients developed biliary complications. Bile leakage and biliary stricture rate was 7.9% and 6.7%, respectively. By univariate analysis, risk factors associated with bile leakage were older age, cadaveric liver donation, and use of a T-tube. The only protecting factor against bile leakage was the use of a straight intrahepatic stent. Risk factors associated with biliary stricture were rejection and male sex. Multivariate analysis demonstrated that T-tube [odds ratio (OR) =3.45] and older age group (OR =7.98) were the only independent risk factors for bile leakage, whereas graft rejection (OR =4.89) and male sex (OR =5.56) were the only independent risk factors for biliary stricture. Percutaneous transhepatic cholangiography drainage (37.2%) or computed-tomography-guided drainage (27.9%) was the most frequent initial treatment. Biliary event-free rate after initial treatment was 67.6% and 66.7% in the non-surgical and surgical group, respectively.

The risk factors for bile leakage and biliary stricture were different due to different pathogenesis. Straight biliary stent in our series showed a protective effect against bile leakage. Non-surgical management can be a highly successful initial treatment, and surgery should be reserved for patients who have failed conservative treatment.