Causes and management of ischemic-type biliary lesion after orthotopic liver transplantation

Abstract

To discuss the causes, diagnosis, prophylaxis and treatment of ischemic-type biliary lesions (ITBLs) following orthotopic liver transplantation (OLT). A retrospective analysis was performed for 326 OLT patients from January 2002 to January 2009. The post-OLT etiological factors and treatment of ITBL cases were analyzed. ITBL occurred in 23 patients (7.05%). It included intrahepatic biliary lesions (n=9), extrahepatic lesions (n=12) and diffuse extrahepatic and intrahepatic biliary lesions (n=2). Through a COX regression, the risk factors were independently associated with ITBL serious hepatitis as the primary disease (RR: 3.204; P=0.014) and cold donor ischemic time beyond 11.5 hours (RR: 4.895; P=0.000). All ITBL patients underwent drug therapy, endoscopy (n=10), operation (n=6) or re-OLT (n=7). And improvement was found in 17 patients. Avoiding too long old ischemic time of donor liver and carefully evaluating the indications of recipients are effective preventive measures of ITBL. It is crucial to select a proper treatment according to the conditions of each individual patient.