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

Abstract

To investigate the cause, prophylaxis, and management of ischemic-type biliary lesion (ITBL) after orthotopic liver transplantation. The clinical data of 212 operations of orthotopic liver transplantation on 209 patients, 184 males and 25 females, aged 44.5 (18-69), including 3 patients undergoing secondary liver transplantation, between February 1999 and August 2004 were reviewed retrospectively. ITBL occurred in 14 patients (6.6%), among whom 5 had biliary lesions of hepatic bifurcation, 3 had intrahepatic biliary lesions, and 6 had multiple extrahepatic and intrahepatic biliary lesions. The incidence rate of ITBL among the recipients of liver in cold storage for more than 10 hours, with donor-recipient ABO blood type incompatibility, with postoperative hepatic arterial lesions, and with hepatitis B related hepatic failure as the primary disease were 9.8% (10/102), 22.2% (2/9), 40% (2/5), and 14.6% (7/48) respectively. The 14 patients with ITBL were managed with conservative treatment, endoscopy, Roux-en-Y anastomosis, or re-transplantation. Seven of the 14 patients were cured, the condition of 5 patients was improved, and 1 patient died with a mortality of 7.1% (1/14). The incidence of ITBL-related graft loss was 23% (3/14). It is crucial to avoid too long preservation time of donor liver and donor-recipient ABO blood type incompatibility, and timely management of postoperative hepatic arterial lesions so as to prevent ITBL. Proper treatment for ITBL should be chosen according to the specific conditions of the lesion of biliary duct tree.