Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Hepatobiliary Pancreat Dis Int. 2011 Aug;10(4):374-9. doi: 10.1016/s1499-3872(11)60063-5.
Ischemia-related biliary tract complications remain high after orthotopic liver transplantation. Severe ischemic biliary complications often involve the hepatic duct bifurcation and left hepatic duct, resulting finally in obstructive jaundice. Prevention and management of such complications remain a challenge for transplant surgeons.
All 160 patients were followed up for at least 180 days after transplantation. One-way analysis of variance (ANOVA) and comparative univariate analysis were made using 3 groups (no complications; mild complications; severe complications), to analyze risk factors associated with biliary complications. Multiple logistic regression and linear regression analysis were used to analyze independent risk factors for severe ischemic biliary complications, after excluding other confounding factors.
By ANOVA and comparative univariate analysis, the risk factors associated with biliary complications were preoperative bilirubin level (P=0.007) and T-tube stenting of the anastomosis (P=0.016). Multiple logistic regression analysis showed that the use of T-tube and preoperative serum bilirubin were not independent risk factors for severe ischemic biliary complications after orthotopic liver transplantation. Chi-square analysis indicated that in the incidence of severe ischemic biliary lesions, bile duct second warm ischemic time longer than 60 minutes was a significant risk factor. Linear regression demonstrated a negative correlation between cold preservation time and warm ischemia time.
Preoperative serum bilirubin level and the use of T-tube stenting of the anastomosis were independent risk factors for biliary complications after liver transplantation, but not for severe ischemic biliary complications. The second warm ischemia time of bile duct longer than 60 minutes and prolonged bile duct second warm ischemia time combined with cold preservation time were significant risk factors for severe ischemic biliary complications after liver transplantation with grafts from non-heart-beating donors.
原位肝移植后与缺血相关的胆道并发症仍然很高。严重的缺血性胆道并发症常累及肝管分叉和左肝管，最终导致阻塞性黄疸。预防和处理这些并发症仍然是移植外科医生面临的挑战。
所有 160 例患者均在移植后至少 180 天进行随访。采用单向方差分析（ANOVA）和三组（无并发症；轻度并发症；严重并发症）的比较单变量分析，分析与胆道并发症相关的危险因素。采用多元逻辑回归和线性回归分析，排除其他混杂因素后，分析严重缺血性胆道并发症的独立危险因素。
通过 ANOVA 和比较单变量分析，与胆道并发症相关的危险因素是术前胆红素水平（P=0.007）和吻合口 T 管支架（P=0.016）。多元逻辑回归分析显示，T 管和术前血清胆红素不是原位肝移植后严重缺血性胆道并发症的独立危险因素。卡方分析表明，在严重缺血性胆道病变的发生率方面，胆管第二次热缺血时间超过 60 分钟是一个显著的危险因素。线性回归表明，冷保存时间与热缺血时间呈负相关。
术前血清胆红素水平和吻合口 T 管支架的使用是肝移植后胆道并发症的独立危险因素，但不是严重缺血性胆道并发症的独立危险因素。胆管第二次热缺血时间超过 60 分钟，以及胆管第二次热缺血时间延长与冷保存时间延长相结合，是非心脏死亡供体肝移植后发生严重缺血性胆道并发症的显著危险因素。
