Biliary Stones After Brain Dead Liver Transplantation Today: Rates, Risk Factors, Treatments, and Outcomes

Aims Our aim was to review the rate of biliary duct stones (BDS) after liver transplantation (LT), risk factors, and treatments, and to identify predictive factors for their onset. Methods LTs performed in our center from 2004 to 2014 were studied. Risk factors for the onset of BDS were identified using univariable Cox’s proportional hazards models. Results Three hundred and sixty-four grafts with 317 duct-to-duct end-to-end biliary anastomosis on a T-tube and 47 hepaticojejunal anastomosis (HJ) were analyzed. BDS were identified in 13 of 364 (3.5%) grafts, including 10 duct-to-duct end-to-end biliary anastomosis on a T-tube grafts (3.2%) and 3 HJ grafts (6.4%). Predictive factors for BDS were biliary strictures (hazard ratio [HR] 9.94; 95% confidence interval [95% CI] 3.25–30.4), bilirubin (HR 1.04; 95% CI 1.01–1.06, for 1 unit increase), Model for End-Stage Liver Disease score (HR 1.07; 95% CI 1.01–1.14, for 1 unit increase), surgery time (HR 1.04; 95% CI 1.01–1.08, for 10-minute increase), hepatocellular disease (HR 8.3; 95% CI 1.09–64.0), hepatic artery thrombosis (HR 6.71; 95% CI 1.47–30.6), and retransplantation (HR 3.69; 95% CI 1.02–13.43). Among 51 grafts (14%) with biliary strictures, female sex was identified as a risk factor for BDS (HR 5.19; 95% CI 1.29–20.98). Multimodality treatment of BDS was often successful but open surgery was still needed in 23% of them. One-, 5-, and 10-year graft survival was not influenced by the onset of BDS. Conclusion Main predictive factor for BDS in liver grafts is biliary stricture. Recipient’s age and body mass index failed to show any statistical importance. In grafts with biliary strictures, female sex is the main risk factor for BDS. In the absence of biliary strictures, hepatic artery thrombosis lead to an increase in the risk of BDS. Multimodality treatment of BDS is often successful. BDS do not influence outcome.