Prophylaxis and treatment of operation-correlated complications in orthotopic liver transplantation

Abstract

To investigate the common reasons, prophylaxis and treatment of operation-correlated complications in orthotopic liver transplantation (OLT). Six hundred and forty-seven patients who underwent OLT from Apr 1993 to Dec 2004 were enrolled and analyzed retrospectively. There were totally 39 cases (6.0%, 39/647) of vascular complications including 23 cases (3.6%) of hepatic artery complications, 6 cases (0.9%) of portal vein complications and 10 cases (1.5%) of vena cava complications. All vena cava complications were occurred in the patients of non-cavaplasty. The success rate of stent placement in treatment of hepatic artery stenosis was 2/2; for patients with hepatic artery thrombosis, the success rate of retransplantation was 4/6, that of revasculation and balloon dilation were 3/7 and 2/7 respectively. Stent placement can treat both anastomotic strictures and venae cavae stricture with the cure rate of 3/3 and 10/10 respectively. There were 34 cases of biliary complications, in which 27 cases were in patients with T tube, and 7 cases in without T tube. The incidence of biliary leak and biliary infection was significantly different between these two groups. The modified piggyback (cavaplasty) technique could prevent the incidence of venae cavae complications effectively. Stent placement is an effective way to treat vascular stenosis. And retransplantation should be performed in early hepatic artery thrombosis. It is important to protect the blood supply of biliary system, and choledochostomy without T tube is the first choice for biliary reconstruction.