Biliary Complications Following Liver Transplantation: The First Single-Center Tunisian Experience

Biliary complications remain a major source of morbidity and mortality in liver transplant recipients. In Tunisia, liver transplantation has been performed for twenty years but no study was interested in reviewing the biliary complications occurring after liver transplantation. In this study, we seek to report our experience with the biliary complications after liver transplantation and to identify the risk factors. We conducted a single center retrospective review of 49 liver transplantations performed in 47 patients between 1999 and 2020. The evaluated factors were early and late biliary complications and their predictive factors. The overall biliary complications rate was 38%. The early biliary complications rate was 21% with a bile leakage rate of 13% and a stricture rate of 9%. By means of univariate analysis, the risk factors were umbilical vein repermeabilization (p=0.029), grade 3 esophageal varices (p=0.029), jaundice (p=0.006), hemoglobin level < 10 g/dl (p=0.012), and hepaticojejunostomy (p=0.042). the late biliary complications rate was 41% with a leakage rate of 10%, stricture rate of 38% and lithiasis rate of 7%. By means of univariate analysis, the risk factors were collateral venous circulation (p=0.023) and cold ischemic time > 8 hours (p=0.022). multivariate analysis did not identify any independent predictors. The biliary complications rate found in our study was superior to the ones reported un literature. The risk factors had significant impact only in univariate analysis. Future studies with a larger population and more sophisticated methodology might accord more credits to our conclusions.