Liver transplantation for iatrogenic bile duct injuries sustained during cholecystectomy

Abstract

Purpose: The aim of this study was to report a single-center experience and review the literature on liver transplantation (LT) for iatrogenic bile duct injury (BDI) sustained during cholecystectomy.

Methods: A retrospective review of a prospectively maintained database of LT between 1990 and December 2012 was performed. For the same period, a review of the literature on LT for BDI was undertaken.

Results: Six patients, with a mean age of 55.3 years (range 52-65), referred at a mean interval of 206 months (range 96-384) from BDI underwent LT. All patients had class E Strasberg BDIs and were referred with end-stage liver disease after multiple previous attempts at BDI repairs. Mortality, morbidity, and retransplantation rates were 16.6, 50, and 16.6 %, respectively. Five patients were alive at a mean follow-up time of 80.4 ± 92 months. Fifty-eight patients listed or transplanted for BDI were identified and reviewed. Indications for LT included chronic or acute liver failure (22.4 %) and the delay between BDI and referral for LT ranged from 1 day to 180 months. Associated vascular injuries were present in 41.3 % of the patients, and 72.4 % of the patients had previous failed BDI repairs. The overall postoperative mortality was 34.4 %, and the morbidity ranged from 60 to 100 %. The overall 5-year survival reached 75 %.

Conclusions: A long interval of time between BDI and referral to tertiary centers for repair, a high rate of associated vascular injuries, and multiple failed previous repair attempts characterize the clinical history of patients undergoing LT for BDI. Operative morbidity and mortality rates of LT in the setting of BDI are particularly high for patients with bilio-vascular injuries presenting with acute liver failure and for patients with chronic liver disease due to multiple previous repair attempts and recurrent preoperative biliary infection.

Keywords: Acute liver failure; Bile duct injury; Laparoscopic cholecystectomy; Liver transplantation; Secondary biliary cirrhosis; Vascular injury.