open access

Vol 14, No 1-2 (2012)
Review articles
Published online: 2012-11-19
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Biliary complications after orthotopic liver transplantation in adults

Anna Stańczyk, Robert Król, Jacek Ziaja, Jacek Pawlicki, Lech Cierpka
Chirurgia Polska 2012;14(1-2):81-94.

open access

Vol 14, No 1-2 (2012)
Review articles
Published online: 2012-11-19

Abstract

Liver transplantation has become at present the treatment of choice in cases of end-stage liver disease. Along with the significant development of transplantology and immunology, the results of liver transplantation have been gradually improving. Currently, the 5-year survival rate in recipients following orthotopic liver transplantation (OLT) is at a level of 72–77%, depending on the stage of liver insufficiency. The presence of complications is inseparably connected with the procedure of liver transplantation, and occur in 80% of cases during the first six months after OLT. One of the most common are complications concerning bile ducts. The most important and widely described are bile leakages, anastomotic and nonmagnetyczanastomotic strictures, bile concrements, sphincter of Oddi dysfunction and compression of the biliary tract. Such complications are dangerous as many times they lead to the loss of the graft or even death. Despite permanent improvements in the surgical technique of performing bile ducts anastomoses and the growing experience of transplantologists, biliary anastomosis is often called the “Achilles heel” of liver transplantation. Nowadays, the prevalence of biliary complications is at a level of 6–35% of all liver transplantations, and most frequently oscillates around 20%, a figure which has been showing a regular downward trend for many years. The most commonly-listed risk factors of biliary complications after OLT are: preoperative serum bilirubin level and INR in recipient, T-tube drainage, the number of fresh frozen plasmas used during the operation and the type of liver graft. Management options, in cases of suspicion of biliary complications, have also changed with Magnetic Resonance Cholangiopancreatography (MRCP) having become a “gold standard” in diagnostics. In the cases of confirmation of the diagnosis of biliary complications, surgical techniques have mainly been replaced by endoscopic or percutaneous techniques. In cases of the ineffectiveness of the above-mentioned treatment, liver re-transplantation becomes necessary. Because of the continuously insufficient number of deceased donors, more and more new methods of expanding the number of grafts for transplantation are being discovered. The methods of gaining the grafts from partial hepatectomy from living donors and division of the liver into smaller parts from a deceased donor have also been introduced. The aim of this article is to be a review and analysis of reports concerning biliary complications after orthotopic liver transplantation in adults. This problem has becomes especially important due to more and more liver transplantations being performed in Poland.

Abstract

Liver transplantation has become at present the treatment of choice in cases of end-stage liver disease. Along with the significant development of transplantology and immunology, the results of liver transplantation have been gradually improving. Currently, the 5-year survival rate in recipients following orthotopic liver transplantation (OLT) is at a level of 72–77%, depending on the stage of liver insufficiency. The presence of complications is inseparably connected with the procedure of liver transplantation, and occur in 80% of cases during the first six months after OLT. One of the most common are complications concerning bile ducts. The most important and widely described are bile leakages, anastomotic and nonmagnetyczanastomotic strictures, bile concrements, sphincter of Oddi dysfunction and compression of the biliary tract. Such complications are dangerous as many times they lead to the loss of the graft or even death. Despite permanent improvements in the surgical technique of performing bile ducts anastomoses and the growing experience of transplantologists, biliary anastomosis is often called the “Achilles heel” of liver transplantation. Nowadays, the prevalence of biliary complications is at a level of 6–35% of all liver transplantations, and most frequently oscillates around 20%, a figure which has been showing a regular downward trend for many years. The most commonly-listed risk factors of biliary complications after OLT are: preoperative serum bilirubin level and INR in recipient, T-tube drainage, the number of fresh frozen plasmas used during the operation and the type of liver graft. Management options, in cases of suspicion of biliary complications, have also changed with Magnetic Resonance Cholangiopancreatography (MRCP) having become a “gold standard” in diagnostics. In the cases of confirmation of the diagnosis of biliary complications, surgical techniques have mainly been replaced by endoscopic or percutaneous techniques. In cases of the ineffectiveness of the above-mentioned treatment, liver re-transplantation becomes necessary. Because of the continuously insufficient number of deceased donors, more and more new methods of expanding the number of grafts for transplantation are being discovered. The methods of gaining the grafts from partial hepatectomy from living donors and division of the liver into smaller parts from a deceased donor have also been introduced. The aim of this article is to be a review and analysis of reports concerning biliary complications after orthotopic liver transplantation in adults. This problem has becomes especially important due to more and more liver transplantations being performed in Poland.
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Keywords

liver transplantation; biliary complications; hepatic artery thrombosis

About this article
Title

Biliary complications after orthotopic liver transplantation in adults

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 14, No 1-2 (2012)

Pages

81-94

Published online

2012-11-19

Bibliographic record

Chirurgia Polska 2012;14(1-2):81-94.

Keywords

liver transplantation
biliary complications
hepatic artery thrombosis

Authors

Anna Stańczyk
Robert Król
Jacek Ziaja
Jacek Pawlicki
Lech Cierpka

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