S-H Wang1, P-Y Lin2, J-Y Wang3, H-C Lin4, C-E Hsieh1, Y-L Chen5. 1. Organ Transplant Center, Changhua Christian Hospital, Changhua, Taiwan. 2. Transplant Medicine and Surgery Research Centre, Changhua Christian Hospital, Changhua, Taiwan. 3. Department of Health Care Administration, Asia University, Taichung, Taiwan. 4. Department of Senior Citizen Welfare and Business, Hung Kuang University, Taichung, Taiwan. 5. Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan, and School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: 31560@cch.org.tw.
Abstract
BACKGROUND: Biliary leakage after T-tube removal is a frequent cause of morbidity in liver transplant recipients. The aim of this study was to determine the factors that predict the development of biliary leakage after T-tube removal in living donor liver transplantation (LDLT) recipients. METHODS: Of the 144 patients who underwent LDLT with right-lobe liver grafts during the period January 2007 to May 2013 at a single medical center, 40 received biliary anastomosis with T-tube placement. Subjects were grouped into either a biliary leakage or non-biliary leakage group on the basis of the presence or absence of abdominal symptoms associated with signs of peritoneal irritation after T-tube removal. Recipient, graft, operative, and postoperative factors were included in a forward, stepwise multiple logistic regression model to identify the most important risk factors for biliary leakage after T-tube removal. RESULTS: Biliary leakage developed in 9 (22.5%) patients after T-tube removal. Risk factors associated with biliary leakage included the number of abdominal surgeries performed [odds ratio (OR) = 12.6, 95% confidence interval (CI): 2.1-20.4] and duration of T-tube placement (OR = 6.9, 95% CI: 1.2-10.7). CONCLUSIONS: Biliary leakage after T-tube removal is associated with significant morbidity in LDLT recipients. We suggest that T-tube placement be used sparingly in LDLT biliary reconstruction. When used, a T-tube should not be removed earlier than 8 months after placement, especially in recipients who have received primary abdominal surgery.
BACKGROUND: Biliary leakage after T-tube removal is a frequent cause of morbidity in liver transplant recipients. The aim of this study was to determine the factors that predict the development of biliary leakage after T-tube removal in living donor liver transplantation (LDLT) recipients. METHODS: Of the 144 patients who underwent LDLT with right-lobe liver grafts during the period January 2007 to May 2013 at a single medical center, 40 received biliary anastomosis with T-tube placement. Subjects were grouped into either a biliary leakage or non-biliary leakage group on the basis of the presence or absence of abdominal symptoms associated with signs of peritoneal irritation after T-tube removal. Recipient, graft, operative, and postoperative factors were included in a forward, stepwise multiple logistic regression model to identify the most important risk factors for biliary leakage after T-tube removal. RESULTS: Biliary leakage developed in 9 (22.5%) patients after T-tube removal. Risk factors associated with biliary leakage included the number of abdominal surgeries performed [odds ratio (OR) = 12.6, 95% confidence interval (CI): 2.1-20.4] and duration of T-tube placement (OR = 6.9, 95% CI: 1.2-10.7). CONCLUSIONS: Biliary leakage after T-tube removal is associated with significant morbidity in LDLT recipients. We suggest that T-tube placement be used sparingly in LDLT biliary reconstruction. When used, a T-tube should not be removed earlier than 8 months after placement, especially in recipients who have received primary abdominal surgery.
Authors: Emad Hamdy Gad; Eslam Ayoup; Amr M Aziz; Tarek Ibrahim; Mostafa Elhelbawy; Mohammed Al-Sayed Abd-Elsamee; Ahmed Nabil Sallam Journal: Ann Med Surg (Lond) Date: 2022-04-14
Authors: Riccardo Pravisani; Paolo De Simone; Damiano Patrono; Andrea Lauterio; Matteo Cescon; Enrico Gringeri; Michele Colledan; Fabrizio Di Benedetto; Fabrizio di Francesco; Barbara Antonelli; Tommaso Maria Manzia; Amedeo Carraro; Marco Vivarelli; Enrico Regalia; Giovanni Vennarecci; Nicola Guglielmo; Manuela Cesaretti; Alfonso Wolfango Avolio; Maria Filippa Valentini; Quirino Lai; Umberto Baccarani Journal: Updates Surg Date: 2021-04-01