Predisposing Factors for Biliary Complications Following Liver Transplantation A. Sanni, J. Asher, C. Wilson, H. Wyrley-Birch, D. Vijayanand, B. Jaques, D. Talbot, and D. Manas ABSTRACT Introduction. Biliary complications remain a major cause of morbidity and mortality in patients following liver transplantation. We sought to identify possible risk factors predisposing to biliary complications after OLT using duct-to-duct biliary reconstruction. Materials and Methods. We retrospectively reviewed 5 years of prospectively collected donor and recipient data between April 1999 and April 2004. We evaluated the presence of biliary complications, donor and recipient age, cold ischemia time, hepatic artery thrombosis, non-heart-beating donor (NHBD), and graft steatosis (30%). The results were compared with a control group of OLT patients without biliary complications. Results. Among 173 OLT recipients, biliary complications occurred in 28 patients (16.2%), of whom 12 were leaks, 15 strictures, and 1 a nonanastomotic intrahepatic stricture. The mortality following biliary complications was 11%, compared to 6% in the control group. Conclusion. Biliary complications remain a persistent problem in OLT. Analysis of risk factors identified hepatic artery thrombosis and steatosis as predisposing factors. With greater experience, NHBD livers may also prove to be at greater risk of biliary complications. L IVER transplantation is the treatment of choice for chronic liver disease of various causes. The biliary anastomosis has been described as the Achilles heel of liver transplantation. 1,2 Its complications produce significant morbidity (10%–35%) and mortality (2%–7%). 3 Numerous predisposing factors for these complications include pro- longed cold ischemia time, fatty donor liver, use of a non-heart-beating donor, and hepatic artery thrombosis. 4 The aim of this study was to identify risk factors predispos- ing to biliary complications after duct-to-duct biliary recon- struction in liver transplantation. METHODS A prospectively collected database at our facility included all patients who underwent orthotopic liver transplantation between April 1999 and April 2004. We reviewed the medical records of all recipients and donors. Patients with biliary complications were compared with a control cohort of patients without biliary compli- cations. Predisposing factors, such as donor age and type (NHBD), cold ischemia times, significant steatosis in the donor liver, hepatic artery thrombosis, and significant inotrope use before retrieval were compared between the groups. RESULTS One hundred seventy-three orthotopic liver transplants were performed for alcoholic liver disease (24%), paraceta- mol overdose (13%), and primary biliary cirrhosis (15%); the remainder were other causes. Biliary complications devel- oped in 28 patients (16.2%). Table 1 shows the analysis of risk factors confirming the significance of hepatic artery throm- bosis and showing a trend of steatosis toward significance. DISCUSSION Biliary complications following liver transplantation are a common cause of morbidity and mortality. 5 Our series reports a rate of 16%, which is within the range of that seen by previous studies. 2,3 Hepatic artery thrombosis and steatotic donor livers were possible risk factors for biliary complication in this study. However, prolonged cold isch- From the Department of Liver/Renal Transplant, Freeman Hospital, Newcastle upon Tyne, United Kingdom. Address reprint requests to A. Sanni, Department of Liver/Renal Transplantation, Newcastle Upon Tyne. E-mail: aliu_oladipupo@ yahoo.com © 2006 by Elsevier Inc. All rights reserved. 0041-1345/06/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2006.08.008 Transplantation Proceedings, 38, 2677–2678 (2006) 2677