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Updated: Jun 12, 2025
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Published on: March 6, 2021
Anastomotic biliary complications after liver transplantation: a matter of experience?
Ludovica Di Cesare1, Ivan Marchitelli1, Maxime Foguenne1
1Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives et Hépatiques, Hôpital de Hautepierre - Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
Background:
Anastomotic biliary complications (ABCs) after liver transplantation (LT) remain a significant source of morbidity. The influence of a surgeon's experience on the incidence of ABCs has been rarely investigated.
Methods:
A retrospective review of consecutive first LTs performed by a single surgeon over 10 years was conducted. Cumulative sum analysis was used to identify the number of LTs necessary to decrease the rate of ABCs below the benchmark threshold. Multivariate logistic analysis was used to identify the risk factors for ABCs.
Results:
This study included 365 first consecutive LTs by a single surgeon. The incidence of ABCs was 16.9%, and 90 cases were necessary to lower the rate of ABCs below the 6-month benchmark threshold (20%). A comparison of 4 clusters of 90 LTs revealed a statistically significant reduction in operative times, cold ischemia times, transfusion rates, and reoperation. However, a similar rate of ABCs was observed. Multivariate analysis identified the following independent risk factors for ABCs: early allograft dysfunction (hazard ratio [HR], 1.87 [95% CI, 1.08-3.25]; P =.025), presence of preoperative portal vein thrombosis (HR, 2.08 [95% CI, 1.20-5.63]; P =.015), need for intraoperative transfusions of >6 units of red blood cell (HR, 1.92 [95% CI, 1.04-3.54]; P =.035), and graft common bile duct of <5 mm (HR, 2.62 [95% CI, 1.34-5.13]; P =.005). Only the use of a T-tube was associated with the occurrence of late biliary fistulas (9 ABCs [14.5%]).
Conclusion:
In LT, increased experience does not improve the rate of ABCs. Factors, such as early allograft dysfunction, increased perioperative bleeding, preoperative portal vein thrombosis, and thin bile ducts, are associated with an increased rate of ABCs.
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