Chinese medical journal · 2002
Experiences relating to management of biliary tract complications following liver transplantation in 96 cases.
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Zhou Guangwen, Cai Weiyao, Li Hongwei, Zhu Yue, Fung John J
Аннотация
OBJECTIVE: To investigate best diagnosing methods and therapy for patients with biliary tract complications after liver transplantation and analyze related factors.
METHODS: A review was made of data collected from 96 patients, and confirmed by retrospective case notes examination.
RESULTS: A total of 94 patients (97 grafts) survived more than 2 days after transplantation; of whom, 92 had an end-to-end biliary anastomosis with a T tube. The average follow-up was 5.8 months (range: 0.3 - 10.2 months). Among the 94 patients, eight (8.5%, 8/94) had complications: leakage during T-tube removal (2 patients), leakage at an earlier stage (2), simultaneous stricture and leak (2) and just stricture (2). Six patients with biliary tract complications had predisposing factors including hepatic artery stenosis (2 patients, including one hepatic artery stenosis combined with severe rejection, hepatic artery thrombosis (3), and donor-recipient bile duct mismatch (1). There was no difference in cold ischemic time. With hepatic artery thrombosis and/or stenosis > 50%, five patients were re-transplanted; without hepatic artery thrombosis and/or stenosis < 50%, three patients required endoscopic stenting and radiological percutaneous drainage of bile collection with or without balloon dilation. All patients survived.
CONCLUSIONS: Biliary strictures occur later than leaks after surgery. Without hepatic artery thrombosis and/or stricture, there is no need for surgery; with hepatic artery thrombosis and/or stricture > 50%, re-transplantation is needed as early as possible.
METHODS: A review was made of data collected from 96 patients, and confirmed by retrospective case notes examination.
RESULTS: A total of 94 patients (97 grafts) survived more than 2 days after transplantation; of whom, 92 had an end-to-end biliary anastomosis with a T tube. The average follow-up was 5.8 months (range: 0.3 - 10.2 months). Among the 94 patients, eight (8.5%, 8/94) had complications: leakage during T-tube removal (2 patients), leakage at an earlier stage (2), simultaneous stricture and leak (2) and just stricture (2). Six patients with biliary tract complications had predisposing factors including hepatic artery stenosis (2 patients, including one hepatic artery stenosis combined with severe rejection, hepatic artery thrombosis (3), and donor-recipient bile duct mismatch (1). There was no difference in cold ischemic time. With hepatic artery thrombosis and/or stenosis > 50%, five patients were re-transplanted; without hepatic artery thrombosis and/or stenosis < 50%, three patients required endoscopic stenting and radiological percutaneous drainage of bile collection with or without balloon dilation. All patients survived.
CONCLUSIONS: Biliary strictures occur later than leaks after surgery. Without hepatic artery thrombosis and/or stricture, there is no need for surgery; with hepatic artery thrombosis and/or stricture > 50%, re-transplantation is needed as early as possible.