Biliary Complications After Liver Transplantation: Incidence, Risk Factors and Impact on Patient and Graft Survival

Abstract Introduction Biliary leaks and anastomotic strictures are common early biliary complications (EBC) following liver transplantation. However, their impact on outcomes remains controversial and poorly described. Method The NHS registry on adult liver transplantation between 2006 and 2017 was retrospectively reviewed (n=8304). Multiple imputations were performed to account for missing data. Adjusted regression models were used to assess predictors of EBC, and their impact on outcomes. 35 potential variables were included, and backwards stepwise selection enabled unbiased selection of variables for inclusion in final models. Result EBC occurred in 9.6% of patients. Adjusted cox regression revealed that EBCs have a significant and independent impact on graft survival (Leak HR=1.325; P=0.021, Stricture HR=1.514; P=0.002, Leak plus stricture HR=1.533; P=0.034) and patient survival (Leak HR=1.218; P=0.131, Stricture HR=1.578; P<0.001, Leak plus stricture HR=1.507; P=0.044). Patients with EBC had longer median hospital stay (23 versus 15 days; P<0.001) and increased chance for readmission within the first year (56% versus 32%; P<0.001). On adjusted logistic regression the following were identified as independent risk factors for development of EBC: donation following circulatory death (OR=1.280; P=0.009), accessory hepatic artery (OR=1.324; P=0.005), vascular anastomosis time in minutes (OR=1.005; P=0.032) and ethnicity ‘other’ (OR=1.838; P=0.011). Conclusion EBCs prolong hospital stay, increase readmission rates and are independent risk factors for diminished graft survival and increased mortality in liver transplantation. We have identified factors that increase the likelihood of EBC occurrence; further research into interventions to prevent EBCs in these at-risk groups is vital to improve liver transplantation outcomes. Take-home message Using a large registry database we have shown that early anastomotic biliary complications are independent risk factors for decreased graft survival and increased mortality after liver transplantation. Research into interventions to prevent biliary complications in high risk groups are essential to improve liver transplant outcomes.

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Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation

Liver Transplantation ◽

10.1002/lt.20693 ◽

2006 ◽

Vol 12 (5) ◽

pp. 831-838 ◽

Cited By ~ 138

Author(s):

Shin Hwang ◽

Sung-Gyu Lee ◽

Kyu-Bo Sung ◽

Kwang-Min Park ◽

Ki-Hun Kim ◽

...

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Biliary Complications ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Incidence Risk

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Patient and Graft Survival: Biliary Complications after Liver Transplantation

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2017.12.039 ◽

2018 ◽

Vol 226 (4) ◽

pp. 484-494 ◽

Cited By ~ 14

Author(s):

Michael Senter-Zapata ◽

Adeel S. Khan ◽

Tanvi Subramanian ◽

Neeta Vachharajani ◽

Leigh Anne Dageforde ◽

...

Keyword(s):

Liver Transplantation ◽

Graft Survival ◽

Biliary Complications ◽

Patient And Graft Survival

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Recipient-Specific Risk Factors Impairing Patient and Graft Outcome after Pediatric Liver Transplantation—Analysis of 858 Transplantations in 38 Years

Children ◽

10.3390/children8080641 ◽

2021 ◽

Vol 8 (8) ◽

pp. 641

Author(s):

Christoph Leiskau ◽

Norman Junge ◽

Eva-Doreen Pfister ◽

Imeke Goldschmidt ◽

Frauke Mutschler ◽

...

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

Graft Survival ◽

Graft Loss ◽

Single Center ◽

Vein Thrombosis ◽

Pediatric Liver ◽

High Urgency ◽

Patient And Graft Survival

(1) Background and Aim: Despite excellent long-term results in pediatric liver transplantation (pLTx), mortality and graft loss still are to be diminished. We aim to describe time-dependent changes and long-term outcome of a large single-center pLTx cohort and to identify independent recipient-related risk factors impairing patient and graft survival. (2) Methods: This is a retrospective single-center study analyzing all pediatric liver transplants from 1983–2020. Risk factors for mortality and graft loss were identified by univariable and multi-linear regression analysis. (3) Results: We analyzed 858 liver transplantations in 705 pediatric patients. Five-year patient/graft survival increased from 60.9%/48.0% (1983–1992) to 97.5%/86.5% (OR = 12.5; p < 0.0001/OR = 6.5; p < 0.0001) (2014–2020). Indications changed significantly over time, with a higher proportion of patients being transplanted for malignancies and metabolic disease and indications of PFIC and α1AT-deficiency declining. The era of transplantation (log7.378/9.657; p < 0.0001) and indication of acute liver failure (log = 1.944/2.667; HR = 2.015/1.772; p = 0.0114/0.002) impairs patient/graft survival significantly in the multivariate analysis. Furthermore, patient survival is worsened by re-transplantation (log = 1.755; HR = 1.744; p = 0.0176) and prolonged waiting times in high-urgency status (log = 2.588; HR = 1.073; p = 0.0026), whereas the indication of biliary atresia improved outcome (log = 1.502; HR = 0.575; p = 0.0315). Graft survival was additionally impaired by pre-existing portal vein thrombosis (log = 1.482; HR = 2.016; p = 0.0330). (4) Conclusions: Despite more complex indications, patient and graft survival after pLTx continue to improve.. Acute liver failure remains the indication with poorest outcome, and listing for high urgency liver transplantation should be considered carefully and early to keep waiting time on HU list short. Furthermore, pre-transplant portal vein thrombosis should be prevented whenever possible to improve graft survival.

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