Retrospective cohort study of management of biliary complications post liver transplantation with risk factors prediction for surgical intervention

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Elwahsh M.E.; Ahmed M.M.; Elmeligy H.A.E.; Gomaa A.M.; Elbaset H.S.E.

Journal: Surgical Chronicles

Publisher: Surgical Society of Northern Greece

Publication Date: 2025

Volume / Issue: Volume 30 / Issue 3

Pages: 313–322

ISSN: 11085002

Scopus: View on Scopus

Document Type: Article

Authors and Affiliations

Elwahsh M.E., General Surgery Department, Faculty of Medicine – Ain Shams University, Cairo, Egypt; Ahmed M.M., General Surgery Department, Faculty of Medicine – Ain Shams University, Cairo, Egypt; Elmeligy H.A.E., Theodor Bilharz Research Institute, Giza, Egypt; Gomaa A.M., Theodor Bilharz Research Institute, Giza, Egypt; Elbaset H.S.E., General Surgery Department, Faculty of Medicine – Ain Shams University, Cairo, Egypt

Abstract

Background: Liver transplantation (LT) is a life-saving therapy for patients with end-stage liver disease or with acute liver failure. Biliary complications (BCs) are the most common complications after LT. Purpose: To assess risk factors, radiological assessment and management of post-liver transplant biliary complications. Methodology: The study included all patients received live-donor liver transplantation in Cairo El-Fatemic Hospital in the duration between 2022 and 2024. All included patients had postoperative biliary complication. Patients with major comorbidities and vascular complications were excluded. Preoperative (donor and recipient), intraoperative and postoperative data were collected. The included patients were divided into 2 groups: Group A: patients who underwent conservative, endoscopic or percutaneous management for biliary complications; Group B: patients who underwent surgical intervention for biliary complications after failure of other methods. Results: After exclusion of early mortality and missed data patients, the total number of patients included in the study was 187 patients. Right lobe was used in 93.6% of patients and 54.5% of patients had double ducts. Duct-to-duct anastomosis was used in 89.3% of patients and ductoplasty was done for 14.7% of patients. Biliary Complications were reported in 13.4% of patients as biliary stricture was found in 10.2% of patients and biliary stricture and leakage was present in 3.2% of patients. Mortality rate among the included patients was 9.5%. Ductoplasty was done in higher percent of patients who experienced postoperative biliary complications (p = 0.018). The significant differences between patients with biliary stricture with and without leakage were total leucocytic count and platelets postoperatively. Age was significantly lower in patients needed re-exploration. SBP was significantly higher in patients needed re-exploration. Ductoplasty was significantly higher among non-survivors (p = 0.04). Conclusion: Postoperative biliary complication was reported in 13.4% of patients and mortality rate was 9.6%. Ductoplasty was associated with higher incidence of postoperative biliary complication. Postoperative biliary complication could be managed safely by ERCP. © 2025, Surgical Society of Northern Greece. All rights reserved.

Keywords

biliary leakage; biliary stricture; ERCP; liver transplantation

Citation Information

Scopus Citations: 0

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