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The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation

Greif, F and Bronsther, OL and Van Thiel, DH and Casavilla, A and Iwatsuki, S and Tzakis, A and Todo, S and Fung, JJ and Starzl, TE (1994) The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Annals of Surgery, 219 (1). 40 - 45. ISSN 0003-4932

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Objective: This study analyzed the incidence and timing of biliary tract complications after orthotopic liver transplantation (OLTx) in 1792 consecutive patients. These results were then compared with those of previously reported series. Finally, recommendations were made on appropriate management strategies. Summary Background Data: Technical complications after OLTx have a significant impact on patient and graft survival. One of the principle technical advances has been the standardization of techniques for biliary reconstruction. Nonetheless, biliary complications still occur. A 1983 report from the University of Pittsburgh reported biliary complications in 19% of all transplants, and an update in 1987 reported biliary complications in 13.2% of transplants. Methods: The medical records of all patients who underwent liver transplantation and were hospitalized between January 1, 1988 and July 31, 1991 were reviewed. The case material consisted of the medical records of 217 patients treated for 245 biliary complications. Results: Primary biliary continuity was established by either choledochocholedochostomy over a T-tube (C-C, n = 129) or a Roux-en-Y choledochojejunostomy with an internal stent (C-RY, n = 85). The overall incidence for biliary complication in this large series was 11.5%. Strictures (n = 93) and bile leak (n = 58) were the most common complications (69.6%). Most biliary complications (n = 143, 66%) occurred within the first 3 months after surgery. In general, leaks occurred early, and strictures developed later. Bile leaks were equally frequent in both C-C and C-RY (27.1% and 25.9%, respectively); strictures were more common after a C-RY type of reconstruction (36.4% and 52.9%, respectively). Twenty-one patients died, an incidence of 9.6%. Fifteen of the 21 biliary-related deaths were among patients treated for rejection before the recognition of biliary tract pathologic findings. Conclusions: Progress has been made on improving the results of biliary reconstruction after OLTx. Nonetheless, patients continue to experience biliary complications after OLTx, and these complications cause considerable loss of grafts and life. If significant additional improvement in patient and graft survival are to be obtained, the technical performance of OLTx must continue to improve.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Greif, F
Bronsther, OL
Van Thiel, DH
Casavilla, A
Iwatsuki, S
Tzakis, A
Todo, S
Fung, JJ
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1994
Date Type: Publication
Journal or Publication Title: Annals of Surgery
Volume: 219
Number: 1
Page Range: 40 - 45
DOI or Unique Handle: 10.1097/00000658-199401000-00007
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0003-4932
Other ID: uls-drl:31735062126093, Starzl CV No. 1759
Date Deposited: 08 Apr 2010 17:29
Last Modified: 02 Feb 2019 13:56


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