Pathogenic analysis and treatment of biliary tract complication following orthotopic liver transplantation

Abstract

Objective To investigate the pathogenesis of biliary tract complication following orthotopic liver transplantation ( OLT) and explore the methods of countermeasures. Methods Clinical data of 74 cases of biliary tract complication following OLT at our institute from 2004 to 2009 were retrospectively analysed. The patterns and high risk factors of biliary tract complication following OLT were summarized. Furthermore the interventing time and efficacy of any treatment for biliary tract complication following OLT were carefully analyzed. Results Bile leakage,biliary sludge,biliary duct stoma stricture,biliary ischemia stricture and biliary cast syndrome were predominant patterns of biliary tract complication following OLT. The inexperience in organ procurement,organ preservation,operating technique and post-operating treating was major factors for bile leakage and biliary duct stoma stricture. The prolong of warm ischemia time was the major factor for biliary sludge and biliary ischemia stricture ( P 0. 01) . At the same time the T-tube and cholangiojejunostomy could induce high morbility of biliary ischemia stricture( P 0. 01) . The organs to be perfused with UW through abdominal aorta had higher morbilities in biliary sludge,biliary ischemia stricture and biliary cast syndrome than those no use with UW( P 0. 05) . Endoscopic and radiative interventionswere effective methods for bile leakage,biliary sludge and biliary duct stoma stricture but unsatisfactory for treating biliary ischemia stricture and biliary cast syndrome. Retransplantation was a salvage method for invalid cases. Conclusions The biliary tract complication following OLT was directly associated with operation technique, ischemical reperfusion injury, the pattern of biliary duct anastomosis, organ procurement and so on. It was very important to think highly of preventing biliary ischemia stricture and biliary cast syndrome in order to cut down the morbilitis for those severe biliary tract complication following OLT.