INCIDENCE AND MANAGEMENT OF BILIARY COMPLICATIONS AFTER 291 LIVER-TRANSPLANTS FOLLOWING THE INTRODUCTION OF TRANSCYSTIC STENTING

Background. Biliary complications occur frequently after liver transpl antation, and many are historically related to T tubes. Stents placed through the donor cystic duct have been used to attempt to reduce tube -related complications yet maintain access to the biliary tree. Method s. The outcomes of all liver transplant procedures performed at the Un iversity of Michigan between December 7, 1990 (when transcystic stenti ng was first used), and April 6, 1995, were analyzed retrospectively. Preoperative, perioperative, and postoperative variables were studied in relationship to biliary complications. The management of complicati ons was also reviewed. Results. A total of 291 transplants qualified f br study. The overall biliary complication rate was 25%, with no diffe rence between the 237 patients who received transcystic stents, the 28 who received T tubes, I;nd the 26 who received no tube. Among the com plications patients experienced, 65% had stricture(s), 44% had stone o r sludge formation, and 40% had a leak. Complications attributable sol ely to transcystic stents occurred in 4% of cases. Advanced age was th e only preoperative variable associated with complications. Primary sc lerosing cholangitis was associated with intrahepatic strictures, and prolonged cold ischemia time and rejection were associated with stone or sludge formation. Nonoperative management had the highest success r ate for anastomotic stricture (76%) and the lowest for intrahepatic st rictures (65%), Only one death was directly attributable to a biliary complication. Conclusion. Transcystic stenting reduces the incidence o f significant tube-related complications, but not the frequency of oth er biliary complications. Biliary complications can usually be managed percutaneously or endoscopically, although intrahepatic strictures an d large, early leaks frequently require reoperation. Aggressive, early management of these complications can reduce excess mortality to less than 2%.