Z Gastroenterol 2012; 50 - V22
DOI: 10.1055/s-0032-1323871

Risikofaktoren und Management biliärer Komplikationen nach Lebertransplantation

AA Negm 1, TJ Weismüller 1, TO Lankisch 1, AS Schneider 1, S Pischke 1, J Klempnauer 2, MP Manns 1, J Wedemeyer 3
  • 1Medizinische Hochschule Hannover, Gastroenterologie, Hepatologie und Endokrinologie, Hannover, Germany
  • 2Medizinische Hochschule Hannover, Allgemein-, Viszeral- und Transplantationschirurgie, Hannover, Germany
  • 3Klinikum Robert Koch Gehrden, Gastroenterologie, Gehrden, Germany

Background & Aim: Biliary complications (BC) after liver transplantation (LT) remain a major source of morbidity and mortality. Our aim was to focus this complication in a tertiary referral academic LT center.

Methods: Between years 2005 and 2006 a cohort of 179 adult patients received primary LT mainly due to viral hepatitis (30%), alcoholic liver disease (20%), HCC (20%) and PSC (14%) in the LT center of Hannover Medical School was prospectively followed till end of 2009. Comparison between patients with (n=58) and without (n=121) BCs in all the collected peri- and post LT parameters was achieved.

Results: 32% of the patients developed 89 different BCs. Biliary strictures were the leading (57%) followed by biliary stones/casts (25%) then biliary leak (17%) and finally sphincter of Oddi dysfunction (1%).

Risk factors and consequences of BC: Multi-variate analysis revealed that LT due to AIH, ascites pre LT, renal dialysis pre LT, longer CIT and longer operation time are all independent risk factors. The development of BC is associated with significantly shorter survival (p=0.029) and higher mortality rate (p=0.012).

Cholangiographic intervention: ERCP was the main management tool (93%) whereas the surgical repair (7%) was preserved for the severe complications or whenever endoscopic/percutaneous route failed. ERCP presentations (n=243) for all patients were associated with minor post-procedural complications mainly cholangitis (5.8%), pancreatitis (2.5%) and bleeding (1.6%). After all PTCD procedures (n=29) only one complication (3.4%) occurred in form of dislocation of the drainage.

Microbiological analysis of bile: 97% of samples showed positive bacterial growth with total of 229 organisms representing 53 different species. Gram positive organisms were most abundant (48%) followed by gram negative organisms (29%) then fungal growths (14%) and finally anaerobes (8%).

Conclusion: BCs are still major source of morbidity after LT affecting more than 1/3 of the recipients. The more advanced the hepato-renal condition prior LT, the more the risk to develop BC post LT. ERCP is successful in the management with minor post interventional complications. Positive bacterial growth in bile was detected in almost all patients presented for the management of the BCs.

Update: Lebertransplantation
Freitag, 21. September 2012/08:00–09:30/Saal 3