Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

Table 1 Liver biochemical profile in 40 Patients with biliary complications post OLT depending on time of presentation [Median, (range); mean ± SD]

Liver biochemicalparameters	Post OLT / before any biliarycomplication	On the day of presentation	Ist Follow-up (avg-1 mo) afterendoscopic therapy	IInd Follow-up (avg-3 mo) afterendoscopic therapy
Bilirubin, mg/dL (< 1.3)	1.3	1.3	0.9	1
	(0.5-13.7)	(0.4-35.0)	(0.3-29.0)	(0.4-26.2)
	2.8 ± 0.6	5.1 ± 1.3	2.8 ± 1.0	3.0 ± 1.0
< 30 d	3.3	4.2	1.2	1.4
1-3 mo	1.1	1	0.7	0.7
4-12 mo	1.1	1.2	0.9	0.7
> 12 mo	0.8	1	1.2	1.1
AST, U/L (< 32)	22.5	48.5	20.5	29.5
	(6.0-378.0)	(8.0-313.0)	(4.0-179.0)	(12.0-142.0)
	54.4 ± 14.1	75.4 ± 12.2	38.8 ± 6.5	42.3 ± 5.7
< 30 d	37	64	18	25
1-3 mo	19	40	18	20
4-12 mo	20	46	20	25
> 12 mo	17	40	34	38
ALT, U/L (< 31)	26.5	90.5	30	24
	(4.0-126.0)	(4.0-891.0)	(4.0-216.0)	(5.0-142.0)
	98.8 ± 22.0	145.7 ± 33.1	46.1 ± 8.0	37.2 ± 5.7
< 30 d	125	102	23	25
1-3 mo	97	89	32	23
4-12 mo	26	97	24	24
> 12 mo	19	58	37	30
GGT, U/L (< 38)	74.5	236	123	117
	(14.0-182.0)	(19.0-1748.0)	(9.0-1697.0)	(9.0-1294.0)
	168.5 ± 34.2	388.1 ± 70.9	282.2 + 63.9	233.4 ± 60.4
< 30 d	152	296	123	54
1-3 mo	82	157	96	38
4-12 mo	45	367	103	63
> 12 mo	39	182	235	266
Alkaline phosphatase, U/L (< 104)	107	242	141	127.5
	(24.0-671.0)	(32.0-1799.0)	(47.0-1435.0)	(46.0-1267.0)
	152.7 ± 21.4	345.1 ± 59.1	270.7 ± 51.3	287.3 ± 53.8
< 30 d	107	240	144	120
1-3 mo	130	100	138	117
4-12 mo	75	244	125	110
> 12 mo	107	263	286	423

Table 2 Type and number of complications in patients post OLT (n = 40)

No. of complications	No. of patients	Type of complication
1	20	10 biliary leakage (50%), 7 anastomotic strictures(35%), 1 vanishing bile duct syndrome,ITBL, and abscess (5%) each
2	14	5 anastomotic strictures and biliary leakage (36%), 5 anastomotic strictures and ITBL (36%), 4 other combinations (28%)
> 2	6	2 anastomotic strictures and stones and secondary chonlangitis (33%), 4 other combinations (66%)

Table 3 Spectrum of biliary tract complications (n = 70) and their treatment post OLT

Classification	No. ofcomplications n (%)	Type of treatment
Isolated bile leak	17 (24.3)	Stent +/- Stent exchange PTBD (2 patients) Primary re-operation (3 patients)
Isolated anastomoticstricture	28 (40)	Stent +/- Stent exchange Multiple stenting Bougienage, Balloon dilatation PTBD (2 patients) Primary re-operation (1 patients)
Ischemic type biliarylesion (ITBL)	6 (8.6)	Stent +/- Stent exchange Bougienage, Balloon dilatation
Miscellaneous	19 (27.1)	Stent +/- Stent exchange
Stones	7 (10)	Multiple stenting
Vanishing bile duct	2 (2.8)	Bougienage, Balloon dilatation
Syndrome		Stone extraction
Ductopenic rejection	1 (1.4)
Absecss	5 (7.1)
Secondary cholangitis	2 (2.8)
Ampullary dyskinesia (SOD)	2 (2.8)

SOD: sphincter of Oddi; PTBD: percutaneous transhepatic biliary drainage.

Table 4 Type of complications related to time post OLT

Time elapsedbetween OLD &complication	No. ofcomplication	Type of complication (%)
		IBL	IAS	ITBL	Misc.
≤ 30 d	20	11 (55.0)	7 (35.0)	1 (5.0)	1 (5.0)
1-3 mo	13	5 (38.5)	4 (30.1)	1 (7.7)	3 (23.0)
4-12 mo	22	1 (4.5)	11 (50.0)	2 (9.0)	8 (36.4)
> 12 mo	15	-	6 (40.0)	2 (13.3)	7 (46.7)
Total	70	17 (24.3)	28 (40.0)	6 (8.6)	19 (27.1)

IBL: isolated bile leak; IAS: isolated anastomotic stricture; ITBL: ischemic type biliary lesion; Misc.: miscellaneous.