RISK FACTORS FOR POST-LIVER TRANSPLANT BILIARY COMPLICATIONS IN THE ABSENCE OF ARTERIAL COMPLICATIONS.

Area of Science:

• Hepatobiliary surgery
• Transplant immunology
• Gastroenterology

Background:

• Biliary complications (BC) are the most frequent post-liver transplant issue, affecting up to 34% of patients.
• Identifying modifiable risk factors for BC is crucial for reducing patient morbidity.

Purpose of the Study:

• To identify modifiable risk factors for biliary complications following liver transplantation.
• To decrease post-transplant morbidity by addressing key risk factors.

Main Methods:

• Analysis of clinical data, anatomical characteristics, and surgical features from 306 liver transplants with arterial patency.
• Identification of risk factors associated with BC through univariate and multivariate analyses.

Main Results:

• Biliary complications occurred in 22.9% of patients, with a median onset of 126 days post-transplant.
• Univariate analysis linked BC to younger recipient age (<40y), CMV infection, biliary disease as indication, lower pre-transplant INR, and smaller bile duct diameter (<3 mm).
• Multivariate analysis confirmed CMV infection, lower INR, and shorter bile duct diameter as significant predictors of BC. CMV antigenemia correlated with BC even at sub-threshold levels.

Conclusions:

• Low pre-transplant INR, bile duct diameter <3 mm, and cytomegalovirus (CMV) antigenemia/disease are associated with biliary complications after liver transplantation.
• Routine preemptive CMV inhibition is proposed as a modifiable strategy to reduce biliary morbidity post-liver transplant.