Internal biliary stenting during orthotopic liver transplantation: Anastomotic complications, post-transplant biliary interventions, and survival

Amit K. Mathur, Satish N. Nadig, Stephanie Kingman, Dustin Lee, Kathleen Kinkade, Christopher J. Sonnenday, Theodore H. Welling

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Background: Biliary complications are a leading source of surgical morbidity following orthotopic liver transplantation (OLT). Methods: We examined how prophylactic internal biliary stent placement during OLT affected post-transplant morbidity and mortality in a single-center retrospective cohort study of 513 recipients (2006-2012). Recipient and donor covariates were collected. Biliary complications included major and minor anastomotic leaks, strictures, or stenoses. Multivariate regression models were created to estimate how operative biliary stents affected outcomes. Results: About 87.3% (n = 448) of recipients had a duct-to-duct biliary anastomosis, and 43.1% (n = 221) had biliary stents placed. The biliary complication rate was <15% at five yr, and 44.8% (n = 230) overall. Stenting was not protective from anastomotic biliary complications (p = 0.06). Stenting was associated with a 74% higher adjusted risk of needing multiple endoscopic retrograde cholangiographies (ERCs; odds ratio [OR] 1.74, p = 0.011), and trended toward a lower adjusted risk for repetitive percutaneous transhepatic cholangiography (PTCs; OR 0.56, p = 0.063). Stenting had no effect on the cumulative freedom from biliary complications (p = 0.94). Biliary complications were associated with mortality (HR 1.86, p = 0.014) and was unaffected by stenting (aHR = 0.72, p = 0.246). Conclusions: Biliary stenting during OLT does not deter biliary complications and is associated with higher risk of multiple invasive biliary interventions, particularly ERCs. Surgeons should evaluate the utility of biliary stents at OLT within this context.

Original languageEnglish (US)
Pages (from-to)327-335
Number of pages9
JournalClinical Transplantation
Volume29
Issue number4
DOIs
StatePublished - Apr 1 2015

Keywords

  • Bile duct
  • Biliary complications
  • Liver transplant
  • Stenting

ASJC Scopus subject areas

  • Transplantation

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