Prophylaxis and management of ischemic-type biliary lesion after orthotopic liver transplantation

To investigate the cause, prophylaxis, and management of ischemic-type biliary lesion (ITBL) after orthotopic liver transplantation. The clinical data of 212 operations of orthotopic liver transplantation on 209 patients, 184 males and 25 females, aged 44.5 (18-69), including 3 patients undergoing secondary liver transplantation, between February 1999 and August 2004 were reviewed retrospectively. ITBL occurred in 14 patients (6.6%), among whom 5 had biliary lesions of hepatic bifurcation, 3 had intrahepatic biliary lesions, and 6 had multiple extrahepatic and intrahepatic biliary lesions. The incidence rate of ITBL among the recipients of liver in cold storage for more than 10 hours, with donor-recipient ABO blood type incompatibility, with postoperative hepatic arterial lesions, and with hepatitis B related hepatic failure as the primary disease were 9.8% (10/102), 22.2% (2/9), 40% (2/5), and 14.6% (7/48) respectively. The 14 patients with ITBL were managed with conservative treatment, endoscopy, Roux-en-Y