NONOPERATIVE MANAGEMENT OF BILIARY LEAKS AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Specific therapy should be instituted expeditiously once the diagnosis of a biliary leak has been made in patients who have undergone orthot opic liver transplantation. Controversy exists over whether to use non operative or operative management. The results of 325 consecutive orth otopic liver transplants in 297 adult and pediatric recipients were re viewed. The biliary tract was reconstructed using a choledochocholedoc hostomy anastomosis (254/325 or 78%) or a Roux-en-Y choledochojejunost omy anastomosis (71/325 or 22%). The incidence of biliary leaks was 23 % (74/325). Overall, only 3% (10/325) of the orthotopic liver transpla nt recipients required operative repair of a biliary leak. Biliary lea ks occurring in patients with Roux-en-Y choledochojejunostomy anastomo ses (9/71 or 13%) commonly required operative repair (6/9 or 67%), whe reas leaks that occurred in patients with choledochocholedochostomy an astomoses (65/254 or 26%) seldom required operative repair (4/65 or 6% ). All choledochojejunostomy leaks occurred at the anastomosis, wherea s choledochocholedochostomy leaks occurred either at the anastomosis ( 17/254 or 7%) or the T-tube insertion site (45/254 or 18%). Our study confirms that in centers with proficient endoscopic and interventional radiologic support, resolution of biliary leaks in orthotopic liver t ransplant patients can be achieved with nonoperative management.