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Risk factors and impact of early anastomotic biliary complications after liver transplantation: UK registry analysis

Lookup NU author(s): Dr Sam Tingle, Dr Emily Thompson, Rodrigo Figueiredo, Dr Mark Hudson, Gourab Sen, Steven White, Professor Derek Manas, Colin Wilson

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

© 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.


Publication metadata

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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