Biliary complications following liver transplantation: Single-center experience over three decades and recent risk factors

Table 1 Clinical characteristics of recipient data

Variable	Mean (SD)	Median (range)	n (% of cohort)
MELD	21 (11.5)	18 (6-40)
BMI	24.2 (4.5)	24.7 (15.1-40)
Days on the waiting list	277 (41.5)	143 (0-4299)
Male: Female	915 (57%) to 692 (43%)
Age	46.1 (12)	47.5 (18-73.6)
ICU stay in days	23 (33)	9 (1-276)
Pre-transplant PVT			143 (9)
Creatinine (μmol/L)	121 (92)	86 (38-707)
Bilirubine (μmol/L)	177 (209)	72 (7-930)
Indication HCC			244 (15)
Indication PSC			153 (9.5)
Indication ALF			137 (8.5)
Indication HCV cirrh.			101 (6.3)
Indication alc. cirrh.			104 (6.4)
Indication biliary dis.			326 (20.3)

MELD: Model of End-Stage Liver Disease; BMI: Body mass index; ICU: Intensive care unit; PVT: Portal vein thromboses; HCC: Hepatocellular carcinoma; PSC: Primary sclerosing cholangitis; ALF: Acute liver failure; HCV: Hepatitis C virus.

Table 2 Clinical characteristics of transplant specific data

Variable	Mean (SD)	Median (range)	n (% of cohort)
Gender mismatch			929 (58)
Cold ischemic time (min)	6.9 (220)	593 (152-1696)
Era 1 of transplantation			303 (19)
Era 2 of transplantation			434 (27)
Era 3 of transplantation			453 (28)
Era 4 of transplantation			417 (26)
> 1 arterial anastom.			71 (4.5)
Aortal anastomosis			164 (10.8)
Portal vein interpos. Graft			14 (0.8)
Hepaticojejunostomy			353 (22.4)
Post-transplant HAT			59 (3.7)

HAT: Hepatic artery thrombosis.

Table 3 Clinical characteristics of donor data

Variable	Mean (SD)	Median (range)	n (% of cohort)
Age	42 (16.9)	43 (15-88)
Male: Female	969 (60%) to 624 (40%)
BMI	24.8 (16.6)	24 (20-44)
Pre-transplant ICU stay	8.7 (19.7)	6 (1-383)
Body temperature °C	36.4 (1.0)	36 (33-39)
Bilirubine (μmol/L)	12.5 (11.7)	9.9 (0.9-154)
Creatinine (μmol/L)	96 (79)	80 (12-885)
CRP (mg/L)	127 (108)	114 (0.1-818)
ALT (u/L)	48 (190)	22 (0-1136)
AST (u/L)	59 (2.67)	29 (0-1074)
GGT (u/L)	51.2 (78.6)	24 (0-912)
Urea (mg/dL)	7.2 (8.4)	5.2 (0.2-103)
CMV positivity			805 (50)

BMI: Body mass index; ICU: Intensive care unit; ALT: Alanine aminotransferase; AST: Aspartate transaminase; GGT: Gamma glutamyltransferase; CMV: Cytomegalovirus; CRP: C-reactive protein.

Table 4 Causes of death in transplanted patients over 30 years

Cause of death	No. of patients (% of cohort)
Sepsis	109 (6.8)
Tumor recurrence	103 (6.4)
De novo malignancy	33 (2.1)
Pneumonia	31 (1.9)
Liver graft: Biliary complications	20 (1.3)
Cardiovascular event	18 (1.1)
Liver graft: Chronic rejection	15 (0.9)
Cerebral ischemia	12 (0.8)
Cerebral bleeding	11 (0.7)
Liver graft: HCV reinfection	11 (0.7)
Cerebral edema	9 (0.6%)
Liver graft: HBV reinfection	9 (0.6)
Gastrointestinal bleeding	7 (0.4)
Gastrointestinal perforation	6 (0.4)
Liver graft: Venous thrombosis	6 (0.4)
Lung: Acute respiratory distress syndrome	4 (0.3)
Polytrauma	4 (0.3)
Cerebral infection	3 (0.3)
Liver graft: HCV de novo infection	3 (0.3)
Liver graft: Initial non function	3 (0.3)
Pulmonary embolism	6 (0.4)
Gastrointestinal ischemia	2 (0.1)
Liver graft: Arterial thrombosis	2 (0.1)
Suicide	2 (0.1)
Liver graft: Portal vein thrombosis	1 (0.1)
Non-compliance to immunosuppression	1 (0.1)
Recurrent alcoholism	1 (0.1)
Unknown	129 (8.1)
Total	561 (35.1)

HCV: Hepatitis C virus; HBV: Hepatitis B virus.

Table 5 Univariable and multivariable analyses for identification of risk factors for anastomotic biliary complications since 2006

	Variable	Univariable analysis		Multivariable analysis
		P-value	OR (95%CI)	P-value	OR (95%CI)
Recipient data	MELD	0.029	1.036 (1.003-1.050)	0.006	1.035 (1.010-1.060)
	BMI	0.438
	Days on the waiting list	0.594
	Gender	0.494
	Age	0.752
	ICU stay in days	0.025	1.018 (1.001-1.012)	0.093
	Pre-transplant PVT	0.056
	Creatinine	0.042	1.003 (1.001-1.005)
	Bilirubine	0.034	1.001 (1.001-1.002)
	Indication HCC	0.328
	Indication PSC	0.415
	Indication ALF	0.620
	Indication HCV cirrh.	0.685
	Indication alc. cirrh.	0.769
	Indication biliary dis.	0.115
Transplant-specific data	Gender mismatch	0.620
	Cold ischemic time	0.417
	Era of transplantation	0.124
	Preservation solution	0.746
	> 1 arterial anastom.	0.396
	Aortal anastomosis	0.331
	Portal vein interpos. Graft	0.251
	Hepaticojejunostomy	0.425
	Post-transplant HAT	0.048	2.999 (1.010-8.056)	0.019	3.543 (1.283-10.178)
	Operative duration	0.624
Donor-specific data	Age	0.738
	Gender male	0.003	1.835 (1.050-3.303)	0.066
	BMI	0.014	0.923 (0.861-0.990)	0.056
	Pre-transplant ICU stay	0.115
	Body temperature	0.921
	Bilirubine	0.022	1.027 (1.005-1.050)	0.073
	Creatinine	0.020	1.003 (1.001-1.005)	0.010	1.003 (1.001-1.006)
	CRP	0.406
	ALT	0.765
	AST	0.613
	GGT	0.278
	Urea	0.581
	CMV positivity	0.100

MELD: Model of End-Stage Liver Disease; BMI: Body mass index; ICU: Intensive care unit; ALT: Alanine aminotransferase; AST: Aspartate transaminase; GGT: Gamma glutamyltransferase; CMV: Cytomegalovirus; PVT: Portal vein thromboses; HCC: Hepatocellular carcinoma; PSC: Primary sclerosing cholangitis; ALF: Acute liver failure; HCV: Hepatitis C virus; CRP: C-reactive protein.