ENDOSCOPIC TREATMENT OF BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION, SINGLE CENTRE EXPERIENCE

Aims:

Biliary complications are common in liver transplant recipients with incidence as high as 32%. The most common complications are biliary strictures and biliary leak. ERCP is a primary treatment modality in those patients; clinical success depends on the type of complication.

The aim of our study was to assess frequency and outcome of biliary complications in a single, large volume transplant centre.

Methods:

We retrospectively reviewed medical records of all adult patients who underwent orthotopic liver transplantation (OLT) between January 2005 and November 2016. We analysed all cases of biliary complications and evaluated outcome of endoscopic treatment. We compared survival rate and retransplantation rate of patients with and without biliary complications.

Results:

In selected period 1037 patients underwent OLT, 248 (23.9%) of them were diagnosed with biliary complication; 142 patients had biliary stenosis (57.2%), biliary leak occurred in 85 patients (34.2%), the remaining 21 patients had other complication (8.6%.).

A total of 811 ERCPs were performed in 199 patients. Endoscopic treatment led to resolution of biliary complication in 162 cases (81.8%); the average number of procedures required for clinical success was four. Treatment success differed significantly in the group of patients with biliary stenosis and leak (92% vs. 42%; p = 0.001). There was a statistically significant difference in survival and retransplantation rates between patients who had biliary complication compared to a control group (24% vs. 13.9%; p = 0. 004, respectively 11.6% vs. 3.9%; p = 0.001).

Conclusions:

Biliary complications after liver transplantation have significant impact on patients and liver-graft survival. Endoscopic therapy was effective in treatment of biliary strictures, the success rate in biliary leak was unsatisfactory.