Biliary complications after liver transplantation: diagnosis and treatments

Abstract

Objective To investigate the diagnosis and treatments of biliary complications after liver transplantation. Methods Clinical data of 14 patients with biliary complications after liver transplantation in the First Affiliated Hospital of Chongqing Medical University from August 2007 to August 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 14 patients, 11 cases were male and 3 were female, aged 22-64 years with a median age of 45 years. The allogeneic piggy-back liver transplantation was performed. The bile duct end-to-end anastomosis was applied. The diagnosis, treatments and prognosis of biliary complications were summarized and analyzed. Results The incidence of biliary tract complications after liver transplantation was 12.0% (14/117), including 5 cases of simplex biliary calculi, 4 simplex biliary anastomotic stenosis, 2 ischemic biliary tract injury, 1 simplex bile leakage, 1 bile leakage complicated biliary anastomotic stenosis and 1 biliary calculi complicated with biliary anastomotic stenosis. 6 cases were diagnosed by MRCP, 4 by ERCP and 2 by ultrasound. 7 cases were treated by ERCP, 4 by biliary anastomosis, 1 by abdominal drainage and 1 by secondary liver transplantation due to extensive intrahepatic biliary ischemic injury. 11 cases were cured, 1 died from tumor recurrence, 1 died from multiple organ dysfunction syndrome caused by biliary infection, and 1 was lost to follow-up. Conclusions Biliary complications after liver transplantation are mainly biliary calculi, anastomotic stenosis, ischemic biliary tract injury and bile leakage. MRCP is the optimal diagnostic method, and ERCP is the preferential treatment, followed by cholecystojejunostomy. Secondary liver transplantation is an effective treatment for diffuse intrahepatic ischemic biliary tract injury. Key words: Liver transplantation; Biliary tract; Postoperative complications; Cholangiopancreatography, endoscopic retrograde