4616 Biliary complications after liver transplantation. long term study over 9 years considering 1,017 liver grafts.

Abstract

Introduction: After liver transplantation a variety of different biliary complications occur. The value of endoscopic therapy as an alternative to surgical reconstruction is still unclear. Aim:We investigated post-OLT lesions by means of ERC to identify type, location and functional relevance of bile duct lesions. Furthermore, we evaluated endoscopic success treating post- OLT bile duct lesions. Methods: We performed a retrospective study over the last 9 years (11/90-9/99) considering 1,017 consecutive liver transplantations in 931 patients at our hospital. Results: After liver transplantation 19.8% (202/1,017) of patients received ERC. ERC revealed biliary lesions in 12.2% (124/1,017) of patients after OLT. Since some patients presented two or more lesions a total of 152 biliary lesions could be identified in these 124 patients. Biliary lesions were found in the donor bile duct system (3.6%=37/1.017), the recipient bile duct system (8.5%=87/1.017) or the bile duct anastomosis (2.9%=(29/1.017). Most bile duct anastomosis manifested as anastomotic stenosis caused either by early inflammatory tissue swelling or by late anastomotic scar formation. In contrast, only 0.5% (5/1,017) of anastomotic insufficiencies were identified. Ischemic type biliary lesions (ITBL) and ischemic biliary lesions caused by hepatic artery occlusion were the main lesions in the donor bile duct system. Post-OLT lesions in the recipient bile duct system comprised mainly papillary stenoses (4.8%=49/1,017) as well as bile aggregates (stones, sludge) in 1.2% (11/1.017). Endoscopic therapy was performed by means of EST in 8.9% (91/1,017). In addition, stenoses were dilated by bouginage or balloon dilation. If necessary, stenoses as well as anastomotic insufficiencies were stented. Endoscopic treatment was able to relieve 65.3% (81/124) of patients suffering from post-OLT biliary lesions. These patients needed no additional surgical therapy. Discussion: ERC is able to identify exactly type and location of biliary lesions after OLT which occurred in 12.2% of our patients. Proper identification of bile duct lesions guides further endoscopic treatment strategy. In our hospital endoscopic therapy was able to cure definitely most patients (65.3%) suffering from post-OLT biliary lesions avoiding need for subsequent surgery.