Prevention and Management of Biliary Complication Following Othotopic Liver Transplantation

Objective: To investigate the prevention and treatment of biliary complications following orthotopic liver transplantation(OLT).Methods: The clinical data of 43 patients who underwent orthotopic liver transplantation between October 2001 to March 2003 were studied retrospectively. Results: Postoperative biliary complications occurred in 6 patients, the incidence being 13.95%, including biliary stricture in 3, biliary leakage following extracting the T-tube in 2 and common bile duct leakage in 1. In the first 25 patients, the bile ducts were flushed with UW solution and biliary complications occurred in 5(20.00%), and in the remaining 18 cases, the bile ducts were first flushed thoroughly with Ringer's solution, followed by UW solution instillation and only 1 had biliary complication(5.56%). Three of the 18 cases with T-tube drainage had biliary complications, while out of 25 cases without T-tube drainage, 3 had biliary complications, the incidence being 16.67% and 12.00% respectively. Secondary operation was carried out in only 1 out of 6 patients with biliary complications, another one died of serious pulmonary infection, while the 4 others all recovered satisfactorily with the aid of PTCD flushing, radio-intervention and/or endoscopic air-bladder expansion, and placement of stent. Conclusions: Completely flushing the biliary system with Ringer's solution during the initial period of organ procurement is an efficient method to reduce the occurrence of postoperative biliary complications. Placement of T-tube would depend on the matching of calibers of bile ducts to be anastomosed and the surgeon's skill. The T-tube should be placed for 4 months at least. Most biliary complications could be cured without operation.