Biliary Tract Complications in Liver Transplantation Under Cyclosporin-Steroid Therapy.

Abstract

OMPLICATIONS of bile duct recon- struction in liver transplantation are more frequent than those of vascular anastomoses.I. 2 In earlier times, unrecognized bile duct obstruction was frequently mistaken for graft rejection, and unwise decisions to increase immunosuppression often resulted in fatal septic complications.In other cases, biliary leakage and peritonitis in the early postoperative period limited the adequate use of immunosuppression, resulting in acute graft rejection superimposed on serious septic biliary peritonitis.The problems caused by biliary complications under conventional immunosuppression have been reported in our series I and in the Cambridge series. 2 These, directly or indirectly, caused death in many cases.In this article the incidence, nature and management of biliary complications after liver transplantation will be reported in patients under cyclosporin-steroid therapy. MATERIALS AND METHODS Methods of Bile Duct ReconstructionEnd-to-end choledocho-choledochostomy was the first choice of bile duct reconstruction whenever donor's and recipient's common bile ducts were adequate in size and quality.AT-tube was used as a stent through a small choledochotomy on the recipient's common bile duct when both the donor's and recipient's common bile ducts were large enough to accept at least a French no.8 T-tube (choledocho-choledochostomy with T-tube stent, C-C-T).When the bile ducts were too small to accept a T-tube.or when choledochotomy was considered unwise.a straight