Patient Characteristics or Type of Biliary Anastomosis with or without T-Tube Placement Does Not Influence Biliary Complication Rate after Liver Transplantation

Abstract

Purpose: Biliary complications remain a substantial cause of morbidity following liver transplantation and can lead to reduced patient and graft survival. There are conflicting data on whether different patient characteristics or differences in surgical techniques would affect biliary complication rates after liver transplantation. Our purpose was to evaluate the effect of patient characteristics and surgical technique on development of biliary complications after liver transplantation. Methods: Patients that underwent liver transplantation at our institution during a two year period (2004–2005) were identified. Information collected included age, gender, indication for transplantation, type of biliary anastomosis, and whether a T-tube was placed during the surgery. Immediate and late post operative biliary complications were recorded. Univariable Cox proportional hazards models were used to estimate the hazard rates for factors of interest. Results: Two hundred and thirteen liver transplantations were performed in 202 patients. Eleven patients (5.4%) had two liver transplantations. Seventy seven patients (38.1%) underwent duct-to-duct anastomosis without T-tube placement, 97 patients (48.0%) underwent duct-to-duct anastomosis with T-tube placement, 21 patients (10.4%) underwent Roux-en-Y choledochojejunostomy, and 7 patients (3.5%) underwent choledochoduodenostomy. Median follow-up period was 12 months (Q25, Q75: 2, 21). A total of 76 biliary complications occurred in 55 patients (27.2%). The biliary complications were as follows: 36 (47.4%) duct-to-duct anastomotic strictures, 25 (32.9%) duct-to-duct anastomotic leaks, 6 (7.9%) non-anastomotic ischemic strictures, 4 (5.3%) biliary enteric anastomotic strictures, 3 (3.9%) biliary enteric anastomotic leaks, 1 (1.3%) cystic duct leak, and 1 (1.3%) gallbladder fossa leak. Age, gender, indication for transplantation or type of biliary anastomosis with or without T-tube placement did not influence the complication rate. Conclusion: Patient characteristics or type of anastomosis with or without T-tube placement does not influence biliary complication rate after liver transplantation.