The Achilles Heel of Liver Transplantation

Abstract

Introduction: Biliary complications (BC) still remain the main technical complication of liver transplantation (LT). Management has improved, using more minimally invasive approaches. Materials and methods: Retrospective cohort study on adult deceased-donor LT from June 2013 to June 2021 in a single center analyzing BC, treatment and survival. Statistical analysis with a significance level < 0,05. Results: Over 373 LT, the incidence of BC was 14,2% (n=53). Biliary strictures: 9,7% (n=36, 3 non anastomotic); bile leaks: 2,4% (n=9, 4 anastomotic); bilomas: 4,5% (n=17, 8 intrahepatic); bile duct stones: 1,9% (n=7). Median onset time was 154 days (r: 11-1819). Arterial thrombosis was developed in 20 patients (5,3%), 15 early and 5 late, both significantly associated with BC (p<0,001). Requirements of high doses of inotropic agents during more than 24 hours and need of reintervention were associated with higher BC (p=0,02 and p=0,003). There were no significant differences in terms of age, sex, donor characteristics or ischemia time (median 436 minutes, r: 170-815). Endoscopic treatment: 32 patients (60,4%) with a 78% efficacy. 21 patients required percutaneous drainage, most as bridge treatment. Surgery (conversion to hepaticojejunostomy) was performed in 16 patients (30,2%), with 94% efficacy (1 re-stricture). Re-transplantation was required in 18 patients, half in patients who had BC (p<0,001). Global mortality was 23,9%. Global survival at 30 days, 1 year and 5 years was 91,7%, 83,3% and 74,6%, showing no significant difference with BC. Conclusions: BC can be treated with low impact on survival; surgery has the best results in terms of resolution.