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Reduction of morbidity and mortality from biliary complications after liver transplantation
Author(s) -
Klein Andrew S.,
Savader Scott,
Burdick James F.,
Fair Jeffrey,
Mitchell Mack,
Colombani Paul,
Perler Bruce,
Osterman Floyd,
Williams G. Melville
Publication year - 1991
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840140513
Subject(s) - medicine , liver transplantation , surgery , sedation , common bile duct , radiological weapon , bile duct , biliary tract , transplantation
Abstract Over a 4‐yr period that began October 1, 1986, 103 orthotopic liver transplants were performed on 91 patients at the Johns Hopkins Hospital. Biliary reconstruction at the time of transplantation was performed in standard fashion by an appropriately trained member of the surgical team. Six (7%) patients developed biliary complications, which included three cases of common bile duct stricture and one case each of bile duct obstruction caused by biopsy‐related hemobilia, biloma and a retained fragment of a T tube after removal. Five of the six patients were treated successfully by nonoperative interventional radiological procedures performed under local anesthesia with light intravenous sedation. Reoperative surgery (to remove the T‐tube fragment from subcutaneous tissue) was required for only one patient, and no deaths (0 of 91) were attributable to biliary complications. All six patients are alive and well 6 to 33 mo after the operation with excellent liver function. Our findings would suggest that most biliary complications of orthotopic liver transplants are avoidable and that the few that do appear can usually be managed both safely and effectively by an interventional radiological approach. (H EPATOLOGY 1991;14:818–823).