DIAGNOSTIC FEATURES AND CLINICAL OUTCOME OF ISCHEMIC-TYPE BILIARY COMPLICATIONS AFTER LIVER-TRANSPLANTATION

The clinical significance and outcome of nonanastomotic strictures and dilatations involving only the biliary tree of the graft with a radio logical appearance of biliary ischemia is unknown. Therefore we analyz ed the grafts of 128 patients to evaluate the biochemical, radiologica l and histological features that prompted the diagnosis of ischemic-ty pe biliary stricture and the clinical outcome of this complication. Is chemic-type biliary strictures were diagnosed in 25 patients (19%). In itial 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, t he appearance of ischemic-type biliary stricture in the month after tr ansplantation was predictive for a poor outcome in all six grafts with early onset of ischemic-type biliary strictures. Eighteen patients (7 2%) were treated with biliary stents and repeated dilatations. Long-te rm patency was achieved in 88% of these patients. Repeat transplantati on was performed in six patients (24%); five survived. Finally, patien ts with ischemic-type biliary strictures spent more time in the hospit al during the first year after orthotopic liver transplantation than d id patients without the complication (62 +/- 27 days vs. 37 +/- 20 day s; p less-than-or-equal-to 0.001). This was due to repeated hospitaliz ations and a higher incidence of retransplantation. One-year graft sur vival 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 bilia ry stricture features is associated with poor graft prognosis. The occ urrence of ischemic-type biliary stricture after transplantation is as sociated with increased morbidity, extended hospitalization and a high er incidence of repeat transplantation.