Biliary Complications Following Adult Deceased Donor Liver Transplantation: Risk Factors and Implications at a High-volume US Center

• Authors: Abraham J. Matar, Emory University; Katherine Ross-Driscoll, Emory University; Lisa Kenney, Emory University; Hannah K. Wichmann, Emory University; Joseph Magliocca, Emory University; William Kitchens, Emory University
• Journal Title: Transplantation Direct
• Volume: Volume 7, Number 10
• Publisher: Lippincott, Williams & Wilkins | 2021-10-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1097/TXD.0000000000001207
• Subjects: Health Sciences, Medicine and Surgery

Abstract

Background. Biliary leaks and anastomotic strictures comprise the majority of biliary complications (BCs) following liver transplantation (LT). Currently, there are few large contemporary case series of BCs in adult deceased donor liver transplant (DDLT) recipients in the literature. The purpose of this study was to examine the pretransplant and intraoperative risk factors associated with BCs at a high-volume tertiary care center and determine the impact of these BCs on their posttransplant course and long-term transplant outcomes. Methods. We retrospectively reviewed all adult patients undergoing a DDLT from a donor after brain death (DBD) at Emory University between January 2015 and December 2019. Results. A total of 647 adult patients underwent DDLT from a DBD during the study period and were included in analyses. The median length of follow-up posttransplant was 2.5 y. There were a total of 27 bile leaks (4.2%) and 69 biliary strictures (10.7%). Recipient age and cold ischemic time were identified as risk factors for biliary leak, whereas alcoholic cirrhosis as transplant indication was a risk factor for biliary stricture. Placement of a biliary stent was associated with the development of both biliary leaks and anastomotic strictures. Posttransplant, biliary leaks were a significant risk factor for future episodes of acute rejection but did not impact overall survival. In contrast, biliary strictures were associated with a significantly reduced overall survival at 1- and 4-y post DDLT. Conclusions. BCs are a major source of morbidity and mortality following DDLT, with strictures and leaks associated with distinct posttransplant complications.