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Anastomotic biliary complications post-LT linked to 7 comorbid factors

Researchers identified seven significant risk factors for the development of anastomotic biliary complications following liver transplantation in high-acuity patients, including vascular comorbidities and use of nonabsorbable suture materials in biliary reconstruction, according to a recently published study.

“The ever-increasing acuity among LT recipients limits their ability to tolerate significant postoperative morbidity and emphasizes the importance of identifying factors contributing to biliary complications in these patients,” Fady M. Kaldas, MD, from the David Geffen School of Medicine in California, and colleagues wrote.

The study included 509 liver transplantations performed in 503 patients. Of the 103 patients who experienced anastomotic biliary complications (ABCs), 77 had anastomotic biliary strictures, 29 had bile duct stones, and 25 had anastomotic bile leaks.

Multivariate analysis of patient characteristics showed the following factors significantly associated with development of ABCs:

• hepatic artery thrombosis (OR = 12.41; 95% CI, 2.37-64.87),
• second liver transplantation (OR = 4.05; 95% CI, 1.13-14.5),
• hepatic artery stenosis (OR = 3.81; 95% CI, 1.3-11.17),
• donor hypertension (OR = 2.79; 95% CI, 1.27-6.11),
• recipients with hepatocellular carcinoma (OR = 2.66; 95% CI, 1.23-5.74),
• donor death due to anoxia (OR = 2.61; 95% CI, 1.13-6.03), and
• use of nonabsorbable suture (OR = 2.45; 95% CI, 1.09-5.54).

Specifically, for each type of ABC, risk factors for anastomotic biliary strictures included hepatic artery thrombosis, hepatic artery stenosis, and donors with hypertension. Hepatic artery stenosis was a risk factor for anastomotic bile. Recipients with hepatic artery thrombosis, hepatic artery stenosis, HCC and those who underwent a second LT were at risk for bile duct stones.

“Although some of these factors are not preventable, efforts to reduce the number of factors affecting any given recipient may mitigate ABCs,” Kaldas and colleagues wrote. “A more detailed approach to the study of biliary complications in LT may provide better guidance on their management.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.