The Effect of Hepatic Artery Flow and the Development of Biliary Complications Post Liver Transplant

Abstract

Purpose: This study aims to investigate the relationship between hepatic artery stenosis or thrombosis and the development of biliary tract complications in post liver transplant patients. Methods: A retrospective chart review was performed for all post liver transplant patients who underwent ERCP (Between 1999 and 2009). The presence of hepatic artery stenosis was defined as reduced hepatic artery upstroke on ultrasound and confirmed by CT angiography or conventional angiogram. This was compared between patients found to have biliary complications (defined as biliary strictures, leak, casts, stone or sludge) and those who did not. Statistical analysis was done using Chi square, Fisher exact and two sample T tests. Results: A total of 278 post liver transplant patients underwent ERCP during the study period. Fifty three (19%) had no biliary complications while 222 (79.8%) had at least one biliary complication. Demographic, clinical, and surgical parameters were not statistically different. There was no significant difference between the two groups in the presence of hepatic artery complications; 20.8% vs. 20.3% (p=0.937). In subgroup analysis, hepatic artery stenosis or thrombosis was present in 16.5% of those who had only strictures on ERCP, vs. 20.8% of those who did not have any biliary complications (P=0.525). However, the bile leak subgroup had significantly higher incidence of hepatic artery stenosis compared to those who had no biliary complications; 66.7% vs. 20.8% (p=0.01). Conclusion: In this retrospective study, we found no significant relation between the presence of hepatic artery stenosis or thrombosis and the development of all types of biliary complications when grouped together. However, subgroup analysis showed a significantly higher incidence of hepatic artery complication among patients with biliary leak but not in patients with biliary strictures. We postulate that biliary tree ischemia might have affected the healing process at the surgical anastomosis, which possibly contributed to the higher incidence of biliary leaks. However, we could not statistically prove the same theory in the development of biliary strictures.