PREDICTORS OF BILE LEAKS AFTER T-TUBE REMOVAL IN ORTHOTOPIC LIVER-TRANSPLANT RECIPIENTS

Bile leaks after T-tube removal are a frequent cause of morbidity in o rthotopic liver transplant recipients. The aim of this study was to de termine factors that predict the development of these leaks in liver t ransplant recipients. Records of all patients who had undergone liver transplantation at the University of Washington Medical Center between January 1990 and September 1993 were reviewed. The following were exc luded: patients with a Roux-en-Y anastomosis or inadvertent early T-tu be removal and patients who died or underwent retransplantation before T-tube removal. All T-tube cholangiograms were reviewed blindly by tw o authors. Using logistic regression, several variables were assessed for possible association with bile leaks after T-tube removal; these i ncluded patient demographics, intraoperative variables, and clinical a nd cholangiographic variables related to T-tube removal. Of the 166 li ver transplants performed in 150 patients, 99 transplants in 97 patien ts were evaluable for bile leak after T-tube removal. Thirty-three pat ients developed symptomatic bile leaks, and 21 underwent endoscopic or operative intervention for persistent symptoms, Only duct mural irreg ularities on the final cholangiogram were strongly associated with the development of a bile leak after T-tube removal (P = 0.001). In concl usion, bile leaks after T-tube removal occurred in one-third of patien ts undergoing orthotopic liver transplantation; the majority of these patients required some intervention. Duct mural irregularities were as sociated with bile leaks. Copyrights (C) 1998 by the American Associat ion for the Study of Liver Diseases.