Biliary complications in liver transplantation: Impact of anastomotic technique and ischemic time on short- and long-term outcome

Table 1 Recipient characteristics

Parameters	n (%)
Age	56 (19-72)
Gender
Male	135 (67.5)
Female	65 (32.5)
Indication for LT
Alcoholic cirrhosis	64 (32)
HCC	40 (20)
Acute liver failure	23 (11.5)
Cryptogenic cirrhosis	22 (11)
HBV/HCV cirrhosis	13 (6.5)
PSC	13 (6.5)
Others	25 (12.5)

LT: Liver transplantation; HCC: Hepatocellular carcinoma; HBV/HCV: Hepatitis B/C virus; PSC: Primary sclerosing cholangitis.

Table 2 Donor characteristics

Parameters
Age, yr	56 (12-89)
Gender, n (%)
Male	98 (49)
Female	102 (51)
ICU, d	3 (0-60)
BW, kg	84.5 (30-190)

ICU: Intensive care unit; BW: Bodyweight.

Table 3 Transplantation data

Parameters
WIT, min	44 (20-78)
CIT, min	480 (100-994)
Rescue allocation	93 (46.5)
Anastomotic technique
SS	164 (82)
EE	18 (9)
Hepaticojejunostomy	18 (9)
External biliary drain
T-tube	179 (89.5)
Roeder-drain	15 (7.5)
No drain	6 (3)

CIT: Cold ischemic time; WIT: Warm ischemic time; SS: Side-to-side; EE:End-to-end.

Table 4 Biliary complications in relation to the type of biliary reconstruction technique n (%)

	SS n = 164	P-vaule (vs not SS)	EE n = 18	P-vaule (vs not EE)	HJ n = 18	P-vaule (vs not HJ)
Anastomotic strictures	34 (20.75)	0.183	4 (22.2)	0.715	0	0.031
< 3 mo	29 (17.7)		2 (11.1)
> 3 mo	5 (3.05)		2 (11.1)
Bile leaks	10 (6.1)	0.901	0	0.261	2 (11.1)	0.338
Biliary drain complications	10 (6.1)	0.091	0	0.261	2 (11.1)	0.338
Papillary stenosis	7 (4.3)	0.207	0	0.397	-
ITBL	6 (3.6)	0.244	0	0.434	0	0.434
≤ 1st yr	4 (2.4)
> 1st yr	2 (1.2)
Total	67 (40.9)		4 (22.2)		4 (22.2)

SS: Side-to side; EE: End-to-end; HJ: Hepeaticojejunostomy; ITBL: Ischemic type biliary lesion.

Table 5 Biliary complications in relation to ischemic times, initial postoperative lab-values and specific donor data n (%)

	BC yes	BC no	P-value (χ2)
WIT > 45 min	29 (38.7)	43 (34.4)	0.543
CIT > 10 h	10 (13.3)	28 (22.4)	0.114
ALT init	9 (12)	18 (14.4)	0.631
> 1500 U/L
Bilirubin init	19 (25.3)	36 (28.8)	0.595
> 5 mg/dL
Donor Age	23 (30.7)	29 (23.2)	0.244
> 65 yr
Donor sex
Male	43 (57.3)	55 (44)	0.068
Female	32 (42.7)	70 (56)
Donor ICU stay > 6 d	22 (29.3)	17 (13.6)	0.007
Rescue organ	35 (46.7)	58 (46.4)	0.971

BC: Biliary complications; ALT init: Alanine aminotransferase initial; WIT/CIT: Warm/cold ischemic time; ICU: Intensive care unit.

Table 6 Type and frequency of therapeutic interventions in relation to the biliary complications n (%)

	Percental incidence(Of total n = 200)	Therapy 0(No consequence)	Therapy 1(lab control)	Therapy 2(ERCP/PTCD)	Therapy 3(OP)
Anastomotic-stenosis grades	38 (19)
1	23 (60.5)	0	21 (91.3)	2 (8.7)	0
2	3 (7.9)	0	0	3 (100)	0
3	7 (18.4)	0	2 (28.6)	5 (71.4)	0
4	5 (13.2)	0	0	5 (100)	0
Bile leakage	12 (6)	1 (8.3)	2 (16.7)	3 (25)	6 (50)
Biliary drain complication	12 (6)	7 (58.3)	1 (8.3)	2 (16.7)	2 (16.7)
Papillary stenosis	7 (3.5)	2 (28.57)	1 (14.29)	4 (57.14)	0
ITBL	6 (3)	0	0	6 (100)	0

ITBL: Ischemic type biliary lesion; ERCP/PTCD: Endoscopic retrograde cholangiopancreatography/percutane transhepatic cholangiodrainage; OP: Operation.

Table 7 Short and long term outcome in relation to reconstruction technique, ischemic times and patient groups n (%)

	Cholangitis	ITBL	Rehospitalisation	Re-LT	Death
Rates in total	15 (7.5 )	6 (3 )	21 (10.5)	5 (2.5)	21 (10.5)
Type of reconstruction
SS	14 (93.3)	6 (100)	19 (95)	5 (100)	1 (4.8)
EE	1 (6.7)	0 (0)	2 (5)	0 (0)	0 (0)
HJ	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Ischemic times
CIT > 10 h	2 (13.3)	1 (16.6)	4 (19)	1 (20)	1 (4.8)
WIT > 45 min	6 (40)	1 (16.6)	9 (42.8)	3 (60)	0 (0)
Without complications	0 (0)	0 (0)	0 (0)	1 (20)	0 (0)
Anastomotic stenosis	6 (40)	0 (0)	11 (52.4)	2 (40)	1 (4.8)
Bile leakage	1 (6.6)	0 (0)	1 (4.8)	1 (20)	0 (0)
Biliary drain complication	0 (0)	0 (0)	1 (4.8)	0 (0)	0 (0)
Papillary stenosis	3 (20)	0 (0)	3 (14.3)	0 (0)	0 (0)
ITBL	5 (33.4)	6 (100)	5 (23.7)	1 (20)	0 (0)

SS: Side-to side; EE: End-to-end; HJ: Hepeaticojejunostomy; CIT: Cold ischemic time; WIT: Warm ischemic time; ITBL: Ischemic type biliary lesion; LT: Liver transplantation.