Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 28, 2017; 9(3): 147-154
Published online Jan 28, 2017. doi: 10.4254/wjh.v9.i3.147
Biliary complications following liver transplantation: Single-center experience over three decades and recent risk factors
Alexander Kaltenborn, André Gutcke, Jill Gwiasda, Jürgen Klempnauer, Harald Schrem
Alexander Kaltenborn, André Gutcke, Department of Trauma and Orthopedic Surgery, Federal Armed Forces Hospital Westerstede, 26655 Westerstede, Germany
Alexander Kaltenborn, André Gutcke, Jill Gwiasda, Harald Schrem, Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, 30625 Hannover, Germany
Jürgen Klempnauer, Harald Schrem, Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany
Author contributions: Kaltenborn A and Gutcke A contributed equally to this work; Kaltenborn A, Gutcke A and Schrem H designed the research; Kaltenborn A, Gutcke A, Gwiasda J and Schrem H performed the research; Kaltenborn A, Gutcke A, Klempnauer J and Schrem H contributed relevant data; Kaltenborn A, Gutcke A and Schrem H analyzed the data; Kaltenborn A, Gutcke A, Gwiasda J, Klempnauer J and Schrem H wrote the paper.
Institutional review board statement: The study was reviewed and approved by the institutional review board of Hannover Medical School, Germany (application number 1683-2013).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alexander Kaltenborn, MD, Maj, MC, GAF, Research Fellow, QM and HTA in Transplantation, Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany. kaltenborn.alexander@mh-hannover.de
Telephone: +49-511-5328846 Fax: +49-511-5324010
Received: September 17, 2016
Peer-review started: September 20, 2016
First decision: October 21, 2016
Revised: November 9, 2016
Accepted: November 27, 2016
Article in press: November 29, 2016
Published online: January 28, 2017
Processing time: 127 Days and 7.9 Hours
Abstract
AIM

To identify independent risk factors for biliary complications in a center with three decades of experience in liver transplantation.

METHODS

A total of 1607 consecutive liver transplantations were analyzed in a retrospective study. Detailed subset analysis was performed in 417 patients, which have been transplanted since the introduction of Model of End-Stage Liver Disease (MELD)-based liver allocation. Risk factors for the onset of anastomotic biliary complications were identified with multivariable binary logistic regression analyses. The identified risk factors in regression analyses were compiled into a prognostic model. The applicability was evaluated with receiver operating characteristic curve analyses. Furthermore, Kaplan-Meier analyses with the log rank test were applied where appropriate.

RESULTS

Biliary complications were observed in 227 cases (14.1%). Four hundred and seventeen (26%) transplantations were performed after the introduction of MELD-based donor organ allocation. Since then, 21% (n = 89) of the patients suffered from biliary complications, which are further categorized into anastomotic bile leaks [46% (n = 41)], anastomotic strictures [25% (n = 22)], cholangitis [8% (n = 7)] and non-anastomotic strictures [3% (n = 3)]. The remaining 18% (n = 16) were not further classified. After adjustment for all univariably significant variables, the recipient MELD-score at transplantation (P = 0.006; OR = 1.035; 95%CI: 1.010-1.060), the development of hepatic artery thrombosis post-operatively (P = 0.019; OR = 3.543; 95%CI: 1.233-10.178), as well as the donor creatinine prior to explantation (P = 0.010; OR = 1.003; 95%CI: 1.001-1.006) were revealed as independent risk factors for biliary complications. The compilation of these identified risk factors into a prognostic model was shown to have good prognostic abilities in the investigated cohort with an area under the receiver operating curve of 0.702.

CONCLUSION

The parallel occurrence of high recipient MELD and impaired donor kidney function should be avoided. Risk is especially increased when post-transplant hepatic artery thrombosis occurs.

Keywords: Biliary complications; Liver transplantation; Prognostic model; Risk factors; Multivariable analyses

Core tip: This retrospective study investigates the occurrence of biliary complications in a total of 1607 consecutive liver transplant patients throughout three decades. Since introduction of Model of End-Stage Liver Disease (MELD)-based liver allocation, the recipient’s MELD-score at transplantation, the development of hepatic artery thrombosis post-operatively, as well as the donor creatinine prior to explantation were identified as independent risk factors, thus a combination of high recipient MELD-score and impaired donor kidney function should be avoided. Risk is especially increased when post-transplant hepatic artery thrombosis occurs. A prognostic model for the prediction of anastomotic biliary complications was developed and successfully internally validated.