Liver Transplantation for the Treatment of Complicated Iatrogenic Biliary Injuries: A National Review from the UNOS Dataset.

Background: Liver transplantation (LT) is rarely indicated in the management of iatrogenic bile duct injuries (IBDI), but occasionally it becomes the only remaining therapy. The purpose of this study is to evaluate potential complications of IBDI and their impact on perioperative mortality, graft and patient survival after LT. Methods: The UNOS database was queried for all LT performed in the United States between 1994 and 2014. Of the 101 238 liver transplants performed, 61 were related to IBDI. We performed a case matched analysis in a 5:1 ratio. Results: The median age for patients with IBDI was 50.16+11.7 years with a mean MELD score of 22.6 + 9.8. Patients receiving liver transplantation for IBDI were more likely women (54.1%, p 0.001), had lower incidence of hepatitis C virus infection (4.9%, p 0.001) and longer cold ischemic time (p 0.001). The mean BMI was 25.5+ 5.2) in patients transplanted for IBDI. IBDI was recognized as the strongest independent predictor associated with 8-fold increased risk of early graft loss (p 0.001, OR 8.4) and a 2.9-fold increased risk of 30-day mortality after LT in a case matched analysis (p 0.03). Conclusions: IBDI is an uncommon but challenging indication for liver transplantation. These patients have significantly increased rates of early graft loss. IBDI is an independent factor related to increased risk of perioperative death after LT. Further studies are needed to determine the causes of perioperative complications and identify potential modifiable factors to improve outcomes in patients undergoing transplantation for IBDI. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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