Risk factors of biliary tract complications in adult living livertransplantation

Introduction:Organ transplantation is becoming increasingly common in the world and in our country. The success of surgery and the survival rate are increasing in every age group, emphasizing how important organ transplantation is. Bile tract complications are the most common complications in live adult transplants, with a rate of 25%. Biliary tract complications after liver transplantation; It is classified as anastomotic stenosis, anastomotic leak, and extrahepatic gallstones. These complications are still open to debate today. In this study, biliary tract risk factors were compared. Bile duct anastomosis, their etiology, blood product transfusion, the relationship between vascular anastomosis complications and the bile duct were evaluated. Material and method: In our center, bile duct anastomoses are divided into choledochocholedocostomy, hepaticojejunostomy, choledochocholedochostomy anastomosis with bile duct reconstruction, multiple duct-to-duct anastomosis, multiple hepaticojejunostomy. Vascular complications are divided into groups as hepatic artery, portal vein, and graft. Blood products (ES, TDP , platelet) administered to the patients were examined. Mann-Whitney U Test was used as a statistical test. Results: 227 patients who received live liver transplantation between January 2015 and June 2022 were included in the study. Bile duct anastomosis was divided into 5 groups. Group 1 duct-to-duct anastomosis was the most frequently used anastomosis and was found in 143 (63%) patients in this group, group 2 single duct-to-duct anastomosis after bile duct reconstruction in 41 (18%) patients, group 3 multiple duct-to-duct anastomosis. There were 19 (8,4%) patients with to-duct anastomosis, 16 (7%) patients with group 4 hepaticojejunostomy, and 8 (3,5%) patients with group 5 multiple hepaticojejunostomy. In terms of bile duct complications, 152 of 227 patients (67%) had no complications. If we look at the patients who developed complications; Stenosis complications were observed in 28 of 40 patients who underwent duct-to-duct anastomosis. Bile duct stenosis complications developed in 14 of 17 patients (25,9%) who underwent multiple duct-to-duct anastomosis. Bile duct stenosis complication was observed in 1 (1,9%) of 3 patients who developed complications after multiple bile duct reconstruction. Bile duct stenosis complications developed in 8 (14,8%) of 9 patients who underwent hepaticojejunostomy anastomosis and developed complications (123). Bile duct stenosis complications were observed in 3 (5,6%) of 6 patients who underwent multiple hepaticojejunostomy. Statistically, no significant relationship was observed between biliary stenosis complication and bile duct anastomosis groups (P = 0,19). However, when we examined the bile duct anastomosis groups one by one, stenosis was observed in 14 (25,9%) of the patients with multiple bile duct duct-to-duct anastomosis. At the same time, stenosis was observed in 8 (14,8%) of the patients with single hepaticojejunostomy. A 2-3 fold increase was observed in these two bile duct anastomosis groups, respectively. It can be said that the reason for stenosis in these two groups is that the bile ducts are small in multiple anastomoses and the nutrition is less in enterostomy anastomoses, as in other studies . At the same time, if we look at the bile duct leakage rates, we look at the 10 (47,6%) cases in which duct-to-duct bile duct anastomosis was performed. ) bile duct leakage was observed in 100% of the patients. Bile duct leak complication was observed in 4 (19%) patients who underwent multiple duct-to-duct anastomosis. A bile duct leak complication was observed in 1 (4.8%) patient who underwent bile duct reconstruction. A bile duct leak complication was observed in 1 (4,8%) patient who underwent single hepaticojejunostomy. Bile tract leak complication was observed in 5 (23.8%) patients who underwent multiple hepaticojejunostomy. Statistically, more bile duct leakage was observed in patients who underwent multiple hepaticojejunostomy bile duct anastomosis, the p value is significant (p= 0,036). Conclusion: Among the risk factors examined (etiology, donor, blood product, vascular complication, bile duct type anastomosis), only blood product and bile duct anastomosis type were statistically significant. In our study, leakage was observed more frequently in multiple hepaticojejunostomy bile duct anastomosis (p>0,05). The reason for this is the difficulty of anastomosis and the fact that the nutrition of the enterostomy is less than that of the common bile duct. At the same time, the rate of multiple common bile duct anastomosis in total complications was also high. Although the p value was not significant (p<0,05), the number of stenosis complications was very high. The reason for this is due to the small bile ducts. At the same time, the complication rate was higher in patients who received blood products (erythrocyte suspension, platelet suspension). The reason for this is the high rate of intraoperative bleeding and instability, and the risk of stenosis and leakage due to hypoperfusion. In our multiple biliary tract patients, it is recommended to perform a single anastomosis by performing bile duct reconstruction in the backtable or after the recipient donor liver is placed.