BILE LEAK AFTER HEPATIC TRANSPLANTATION - CHOLANGIOGRAPHIC FEATURES, PREVALENCE, AND CLINICAL OUTCOME

PURPOSE: To evaluate cholangiographic features and prevalence of bile duct leaks in liver transplant recipients and correlate the different types of leaks with clinical outcomes. MATERIALS AND METHODS: For 6 ye ars, 3,242 cholangiograms were obtained in 1,363 liver allografts in 1 ,306 patients. All cholangiograms with definite or suspected bile duct leaks, per the radiology reports, were retrospectively reviewed. RESU LTS: Leaks were diagnosed in 59 allografts in 59 patients. The prevale nce of leaks after liver transplantation, as depicted on cholangiogram s, was 4.3% (59 of 1,363 grafts). Sixteen of 21 patients with anastomo tic leaks needed 17 surgical repairs, four leaks were surgically drain ed without repair, and one was treated with percutaneous biliary cathe ter drainage. Twelve of 21 patients with T-tube exit-site leaks underw ent T-tube drainage. Seven underwent surgical repair or drainage, one died, and one underwent retransplantation. Nine of 13 patients with le aks from bile duct necrosis required retransplantation. CONCLUSION: Bi le duct leaks at biliary anastomoses and those resulting from bile duc t necrosis have high morbidity, mortality, and graft loss rates and us ually require surgical intervention. Most T-tube exit-site leaks heal with conservative treatment.