Liver transplantation as last-resort treatment for patients with bile duct injuries following cholecystectomy: a multicenter analysis

Peter Tsaparas; Nikolaos Machairas; Victoria Ardiles; Marek Krawczyk; Damiano Patrono; Umberto Baccarani; Umberto Cillo; Einar Martin Aandahl; Christian Cotsoglou; Johana Leiva Espinoza; Rodrigo Sanchez Clariá; Ioannis D. Kostakis; Aksel Foss; Vincenzo Mazzaferro; Eduardo de Santibañes; Georgios C. Sotiropoulos

Authors Peter Tsaparas, Nikolaos Machairas, Victoria Ardiles, Marek Krawczyk, Damiano Patrono, Umberto Baccarani, Umberto Cillo, Einar Martin Aandahl, Christian Cotsoglou, Johana Leiva Espinoza, Rodrigo Sanchez Clariá, Ioannis D. Kostakis, Aksel Foss, Vincenzo Mazzaferro, Eduardo de Santibañes, Georgios C. Sotiropoulos.

Abstract

Background Liver transplantation (LT) has been used as a last resort in patients with end-stage liver disease due to bile duct injuries (BDI) following cholecystectomy. Our study aimed to identify and evaluate factors that cause or contribute to an extended liver disease that requires LT as ultimate solution, after BDI during cholecystectomy.

Methods Data from 8 high-volume LT centers relating to patients who underwent LT after suffering BDI during cholecystectomy were prospectively collected and retrospectively analyzed.

Results Thirty-four patients (16 men, 18 women) with a median age of 45 (range 22-69) years were included in this study. Thirty of them (88.2%) underwent LT because of liver failure, most commonly as a result of secondary biliary cirrhosis. The median time interval between BDI and LT was 63 (range 0-336) months. There were 23 cases (67.6%) of postoperative morbidity, 6 cases (17.6%) of post-transplant 30-day mortality, and 10 deaths (29.4%) in total after LT. There was a higher probability that patients with concomitant vascular injury (hazard ratio 10.69, P=0.039) would be referred sooner for LT. Overall survival following LT at 1, 3, 5 and 10 years was 82.4%, 76.5%, 73.5% and 70.6%, respectively.

Conclusion LT for selected patients with otherwise unmanageable BDI following cholecystectomy yields acceptable long-term outcomes.

Keywords Bile duct injury, cholecystectomy, liver transplantation, end-stage liver disease, cholangitis

Ann Gastroenterol 2021; 34 (1): 111-118