Diagnostic features and clinical outcome of ischemic-type biliary complications after liver transplantation

Hepatology. 1993 Apr;17(4):605-9. doi: 10.1002/hep.1840170413.


The clinical significance and outcome of nonanastomotic strictures and dilatations involving only the biliary tree of the graft with a radiological appearance of biliary ischemia is unknown. Therefore we analyzed the grafts of 128 patients to evaluate the biochemical, radiological and histological features that prompted the diagnosis of ischemic-type biliary stricture and the clinical outcome of this complication. Ischemic-type biliary strictures were diagnosed in 25 patients (19%). Initial graft function was similar in all patients, whether or not this complication developed. Most ischemic-type biliary strictures occurred between 1 and 4 mo after orthotopic liver transplantation. However, the appearance of ischemic-type biliary stricture in the month after transplantation was predictive for a poor outcome in all six grafts with early onset of ischemic-type biliary strictures. Eighteen patients (72%) were treated with biliary stents and repeated dilatations. Long-term patency was achieved in 88% of these patients. Repeat transplantation was performed in six patients (24%); five survived. Finally, patients with ischemic-type biliary strictures spent more time in the hospital during the first year after orthotopic liver transplantation than did patients without the complication (62 +/- 27 days vs. 37 +/- 20 days; p < or = 0.001). This was due to repeated hospitalizations and a higher incidence of retransplantation. One-year graft survival was lower in patients with ischemic-type biliary strictures than in patients without ischemic-type biliary strictures (69% vs. 88%; p = 0.006). However, 1-yr patient survival was similar in the two groups (91% vs. 89%). In conclusion, early appearance of ischemic-type biliary stricture features is associated with poor graft prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Actuarial Analysis
  • Bile Ducts / blood supply*
  • Humans
  • Ischemia / diagnosis*
  • Ischemia / mortality
  • Ischemia / surgery
  • Liver Function Tests
  • Liver Transplantation* / mortality
  • Liver Transplantation* / physiology
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / mortality
  • Postoperative Complications / physiopathology
  • Stents
  • Survival Analysis
  • Time Factors
  • Transplantation, Homologous
  • Treatment Outcome