Risk factors of severe ischemic biliary complications after liver transplantation

BACKGROUND:Ischemia-related biliary tract complications remain high after orthotopic liver transplantation.Severe ischemic biliary complications often involve the hepatic duct bifurcation and left hepatic duct,resulting finally in obstructive jaundice.Prevention and management of such complications remain a challenge for transplant surgeons.METHODS:All 160 patients were followed up for at least 180 days after transplantation.One-way analysis of variance (ANOVA) and comparative univariate analysis were made using 3 groups (no complications;mild complications;severe complications),to analyze risk factors associated with biliary complications.Multiple logistic regression and linear regression analysis were used to analyze independent risk factors for severe ischemic biliary complications,after excluding other confounding factors.RESULTS:By ANOVA and comparative univariate analysis,the risk factors associated with biliary complications were preoperative bilirubin level (P=0.007) and T-tube stenting of the anastomosis (P=0.016).Multiple logistic regression analysis showed that the use of T-tube and preoperative serum bilirubin were not independent risk factors for severe ischemic biliary complications after orthotopic liver transplantation.Chi-square analysis indicated that in the incidence of severe ischemic biliary lesions,bile duct second warm ischemic time longer than 60 minutes was a significant risk factor.Linear regression demonstrated a negative correlation between cold preservation time and warm ischemia time.CONCLUSIONS:Preoperative serum bilirubin level and the use of T-tube stenting of the anastomosis were independent risk factors for biliary complications after liver transplantation,but not for severe ischemic biliary complications.The second warm ischemia time of bile duct longer than 60minutes and prolonged bile duct second warm ischemia time combined with cold preservation time were significant risk factors for severe ischemic biliary complications after liver transplantation with grafts from non-heart-beating donors.