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Lookup NU author(s): Dr Sam Tingle, Dr Emily ThompsonORCiD, Rodrigo Figueiredo, Dr Mark Hudson, Gourab Sen, Steven White, Professor Derek Manas, Professor Colin Wilson
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.BACKGROUND: Biliary leaks and anastomotic strictures are common early anastomotic biliary complications (EABCs) following liver transplantation. However, there are no large multicentre studies investigating their clinical impact or risk factors. This study aimed to define the incidence, risk factors and impact of EABC. METHODS: The NHS registry on adult liver transplantation between 2006 and 2017 was reviewed retrospectively. Adjusted regression models were used to assess predictors of EABC, and their impact on outcomes. RESULTS: Analyses included 8304 liver transplant recipients. Patients with EABC (9·6 per cent) had prolonged hospitalization (23 versus 15 days; P < 0·001) and increased chance for readmission within the first year (56 versus 32 per cent; P < 0·001). Patients with EABC had decreased estimated 5-year graft survival of 75·1 versus 84·5 per cent in those without EABC, and decreased 5-year patient survival of 76·9 versus 83·3 per cent; both P < 0.001. Adjusted Cox regression revealed that EABCs have a significant and independent impact on graft survival (leak hazard ratio (HR) 1·344, P = 0·015; stricture HR 1·513, P = 0·002; leak plus stricture HR 1·526, P = 0·036) and patient survival (leak HR 1·215, P = 0·136, stricture HR 1·526, P = 0·001; leak plus stricture HR 1·509; P = 0·043). On adjusted logistic regression, risk factors for EABC included donation after circulatory death grafts, graft aberrant arterial anatomy, biliary anastomosis type, vascular anastomosis time and recipient model of end-stage liver disease. CONCLUSION: EABCs prolong hospital stay, increase readmission rates and are independent risk factors for graft loss and increased mortality. This study has identified factors that increase the likelihood of EABC occurrence; research into interventions to prevent EABCs in these at-risk groups is vital to improve liver transplantation outcomes.
Author(s): Tingle SJ, Thompson ER, Ali SS, Figueiredo R, Hudson M, Sen G, White SA, Manas DM, Wilson CH
Publication type: Article
Publication status: Published
Journal: BJS Open
Year: 2021
Volume: 5
Issue: 2
Print publication date: 01/03/2021
Online publication date: 15/04/2021
Acceptance date: 15/02/2021
Date deposited: 05/05/2021
ISSN (electronic): 2474-9842
Publisher: John Wiley & Sons Ltd
URL: https://doi.org/10.1093/bjsopen/zrab019
DOI: 10.1093/bjsopen/zrab019
PubMed id: 33855363
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