Treatment and prognosis of multiple intra-and extrahepatic ischemic-type biliary lesions following liver transplantation

Abstract

Objective To evaluate the treatment and prognosis of multiple intra-and extrahepat-ic ischemic-type biliary lesions (ITBLs) following liver transplantation. Method A retrospective anal-ysis was made for 31 cases with ITBLs after liver transplantation from December 2004 to May 2006. Results Of the 31 cases with a mean age of(48.6+9.6) years, 28 were male and 3 female. The mean interval from operation to diagnosis of ITBLs was (271.29±149.32) d. Oonly 8 cases combined with severe hepatic artery stenosis and 1 case with bile leakage. The treatment options were divided in-to five categories: (1) Interventional treatments (using ERC or PTC) in 8 cases. (2) Interventional measures were the first-line treatment and then re-transplantation in 7 cases. (3) retransplantation without interventional measures in 5 cases. (4) conservative treatment in 8 cases. (5) hepaticjejunos-tomy in 1 case. Six of the 31 cases were cured, the condition of 7 patients was improved, and 10 pa-tients died. The mortality was 32.3% (10/31). Interventional measures were associated with high mortality (53.3%,8/15)whether these cases received retrasnplantation or not. Six cases were im-proved when they only received conservative treatment and 1 suffering from refractory biliary infec-tions treated with hepaticojejunostomy. Conclusion Interventional treatment could not help to cure the cases with multiple intra-and extrahepatic ITBLs or improve their condition. Proper conservative treatment can effectively avoid or at least delays retransplantation. Timely re-transplantation is essen-tial to cure this complication. Key words: Liver transplantation; Postoperative complication; Bile duct