Liver transplantation across Rh blood group barriers increases the risk of biliary complications

J Gastrointest Surg. 2007 Apr;11(4):458-63. doi: 10.1007/s11605-007-0116-0.


Background: Cold ischemia time and the presence of postoperative hepatic arterial thrombosis have been associated with biliary complications (BC) after liver transplantation. An ABO-incompatible blood group has also been suggested as a factor for predisposal towards BC. However, the influence of Rh nonidentity has not been studied previously.

Materials: Three hundred fifty six liver transplants were performed from 1995 to 2000 at our hospital. BC incidence and risk factors were studied in 345 patients.

Results: Seventy patients (20%) presented BC after liver transplantation. Bile leakage (24/45%) and stenotic anastomosis (21/30%) were the most frequent complications. Presence of BC in Rh-nonidentical graft-host cases (23/76, 30%) was higher than in Rh-identical grafts (47/269, 17%) (P=0.01). BC was also more frequent in grafts with arterial thrombosis (9/25, 36% vs 60/319, 19%; P=0.03) and grafts with cold ischemia time longer than 430 min (26/174, 15% vs 44/171, 26%; P=0.01). Multivariate logistic regression confirmed that Rh graft-host nonidentical blood groups [RR=2(1.1-3.6); P=0.02], arterial thrombosis [RR=2.6(1.1-6.4); P=0.02] and cold ischemia time longer than 430 min [RR=1.8(1-3.2); P=0.02] were risk factors for presenting BC.

Conclusion: Liver transplantation using Rh graft-host nonidentical blood groups leads to a greater incidence of BC.

MeSH terms

  • Aged
  • Bile Duct Diseases / etiology*
  • Blood Group Incompatibility / complications*
  • Female
  • Humans
  • Liver Transplantation* / adverse effects
  • Liver Transplantation* / immunology
  • Male
  • Rh-Hr Blood-Group System*
  • Risk Factors
  • Tissue Donors


  • Rh-Hr Blood-Group System