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. 2017 Apr-Jun;30(2):127-131.
doi: 10.1590/0102-6720201700020011.

BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION

[Article in English, Portuguese]
Júlio Cezar Uili Coelho  1 , Lucas de Oliveira Leite  1 , Antonio Molena  1 , Alexandre Coutinho Teixeira de Freitas  1 , Jorge Eduardo Fouto Matias  1
Affiliations

BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION

[Article in English, Portuguese]
Júlio Cezar Uili Coelho et al. Arq Bras Cir Dig. 2017 Apr-Jun.

Abstract
in English, Portuguese

Background: Biliary reconstitution has been considered the Achilles's heel of liver transplantations due to its high rate of postoperative complications.

Aim: To evaluate the risk factors for occurrence of biliary strictures and leakages, and the most efficient methods for their treatment.

Method: Of 310 patients who underwent liver transplantation between 2001 and 2015, 182 medical records were retrospectively analyzed. Evaluated factors included demographic profile, type of transplantation and biliary reconstitution, presence of vascular and biliary complications, their treatment and results.

Results: 153 (84.07%) deceased donor and 29 (15.93%) living donor transplantations were performed. Biliary complications occurred in 49 patients (26.92%): 28 strictures (15.38%), 14 leakages (7.7%) and seven leakages followed by strictures (3.85%). Hepatic artery thrombosis was present in 10 patients with biliary complications (20.4%; p=0,003). Percutaneous and endoscopic interventional procedures (including balloon dilation and stent insertion) were the treatment of choice for biliary complications. In case of radiological or endoscopic treatment failure, surgical intervention was performed (biliodigestive derivation or retransplantation (32.65%). Complications occurred in 25% of patients treated with endoscopic or percutaneous procedures and in 42.86% of patients reoperated. Success was achieved in 45% of patients who underwent endoscopic or percutaneous procedures and in 61.9% of those who underwent surgery.

Conclusion: Biliary complications are frequent events after liver transplantation. They often require new interventions: endoscopic and percutaneous procedures at first and surgical treatment when needed. Hepatic artery thrombosis increases the number of biliary complications.

Racional:: A reconstituição biliar é considerada o calcanhar-de-Aquiles do transplante hepático devido à sua elevada taxa de complicações pós-operatórias.

Objetivo:: Analisar os fatores de risco para ocorrência de estenoses e fístulas biliares e os métodos terapêuticos mais eficientes para seu tratamento.

Método:: De 310 pacientes transplantados entre 2001 e 2015, 182 prontuários foram analisados retrospectivamente. Foram avaliados o perfil demográfico dos pacientes, tipo de transplante e reconstituição biliar, presença de complicações biliares e vasculares, tratamento utilizado e seus resultados.

Resultados:: Foram realizados 153 (84,07%) transplantes hepáticos cadavéricos e 29 intervivos (15,93%). Complicações biliares ocorreram em 49 pacientes (26,92%): 28 estenoses (15,38%), 14 fístulas (7,7%) e sete fístulas seguidas de estenose (3,85%). Trombose de artéria hepática esteve presente em 10 pacientes com complicações biliares (20,4%, p=0,003). Os tratamentos de escolha foram os procedimentos endoscópicos ou percutâneos (incluindo dilatação por balão e colocação de próteses (40,82%). No insucesso deles, foi realizado tratamento cirúrgico (derivação biliodigestiva ou retransplante (32,65%). Complicações ocorreram em 25% dos pacientes que fizeram procedimentos endoscópicos ou percutâneos e em 42,86% dos submetidos ao tratamento cirúrgico. A resolução das complicações biliares foi de 45% com os procedimentos endoscópicos ou percutâneos e de 61,9% com o cirúrgico.

Conclusão:: Complicações biliares são frequentes após transplante hepático. Comumente requerem novas intervenções. Os procedimentos endoscópicos e percutâneos são a primeira escolha e os cirúrgicos, empregados na falha destes. Trombose de artéria hepática aumenta a incidência de complicações biliares.

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Conflict of interest statement

Conflicts of interest: none

Figures

FIGURE 1
FIGURE 1. Indications of liver transplantation in absolute numbers
FIGURE 2
FIGURE 2. A) Frequency of complications after endoscopic, percutaneous or combinations of these procedures (n=11); B) complications of biliary complications treated surgically with either retransplantation or reanastomosis (n=16)
See this image and copyright information in PMC

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