Diagnostic features and clinical outcome of ischemic‐type biliary complications after liver transplantation

The clinical significance and outcome of nonanastomotic strictures and dilatations involving only the biliary tree of the graft with a radiological appearance of biliary ischemia is unknown. Therefore we analyzed the grafts of 128 patients to evaluate the biochemical, radiological and histological features that prompted the diagnosis of ischemic‐type biliary stricture and the clinical outcome of this complication. Ischemic‐type biliary strictures were diagnosed in 25 patients (19%). Initial graft function was similar in all patients, whether or not this complication developed. Most ischemic‐type biliary strictures occurred between 1 and 4 mo after orthotopic liver transplantation. However, the appearance of ischemic‐type biliary stricture in the month after transplantation was predictive for a poor outcome in all six grafts with early onset of ischemic‐type biliary strictures. Eighteen patients (72%) were treated with biliary stents and repeated dilatations. Long‐term patency was achieved in 88% of these patients. Repeat transplantation was performed in six patients (24%); five survived. Finally, patients with ischemic‐type biliary strictures spent more time in the hospital during the first year after orthotopic liver transplantation than did patients without the complication (62 ± 27 days vs. 37 ± 20 days; p ± 0.001). This was due to repeated hospitalizations and a higher incidence of retransplantation. One‐year graft survival was lower in patients with ischemic‐type biliary strictures than in patients without ischemic‐type biliary strictures (69% vs. 88%; p = 0.006). However, 1‐yr patient survival was similar in the two groups (91% vs. 89%). In conclusion, early appearance of ischemic‐type biliary stricture features is associated with poor graft prognosis. The occurrence of ischemic‐type biliary stricture after transplantation is associated with increased morbidity, extended hospitalization and a higher incidence of repeat transplantation. (HEPATOLOGY 1993;17:605–609.)