Biliary complications following donation after brainstem death liver transplantation

Table 1 Baseline demographic and clinical characteristics of the study population, n (%)/mean (interquartile range)

Variables	Duct to duct anastomosis (n = 240)	RYHJ (n = 126)	P value
Sex			0.851
Male	151 (62.9)	78 (61.9)
Female	89 (37.1)	48 (38.1)
ASA			0.847
2	3 (1.3)	2 (1.6)
3	85 (35.4)	42 (33.3)
4	145 (60.4)	77 (61.1)
5	7 (2.9)	5 (4.0)
Recipient age (years)	56 (16-73)	55 (19-73)	0.410
Donor age (years)	52 (11-89)	49 (11-79)	0.430
NMP	20 (8.3)	13 (10.3)	0.523
UKELD	55 ± 5.3	55 ± 5.0	0.093
Cold ischemia time (minutes)	575 ± 220.5	590 ± 215.8	0.354
LOS (days)	24.5 ± 21.7	29.3 ± 23.7	0.073
Operation length (minutes)	478 ± 118.9	567 ± 203.9	< 0.001

ASA: American Society of Anesthesiologists classification; NMP: Normothermic machine perfusion; UKELD: United Kingdom model for end-stage liver disease; LOS: Length of stay; RYHJ: Roux-en-Y hepaticojejunostomy.

Table 2 Postoperative outcomes, n (%)

Outcomes	Duct to duct anastomosis (n = 240)	RYHJ (n = 126)	P value
Bile leak	16 (6.7)	2 (1.6)	0.030
Anastomotic biliary stricture	30 (12.5)	9 (7.1)	0.040
Ischemic cholangiopathy	12 (5.0)	6 (4.8)	0.842
Hepatic artery thrombosis	15 (6.3)	12 (9.5)	0.120
Early allograft dysfunction	17 (7.1)	12 (9.5)	0.411
Primary non function	3 (1.3)	3 (2.4)	0.418
Acute rejection	25 (10.4)	11 (8.7)	0.795
Reoperation	47 (19.6)	36 (28.6)	0.033
Re-transplantation	11 (4.6)	16 (12.7)	0.005
30 days mortality	26 (10.8)	16 (12.7)	0.280
1-year overall survival	214 (89.2)	110 (87.3)	0.281

RYHJ: Roux-en-Y hepaticojejunostomy.

Table 3 Treatment options for anastomotic biliary stricture, n (%)

Treatment option	Duct to duct anastomosis ABS cases (n = 30)	RYHJ ABS cases (n = 9)	P value
ERCP and stent	9 (30)	0 (0)	0.061
PTC and dilatation	0 (0)	2 (22.2)	0.008a
RYHJ	18 (60)	3 (33.3)	0.159
Conservative	3 (10)	3 (33.3)	0.089
Retransplant	0 (0)	1 (11.1)	0.064

^aP < 0.01.

ERCP: Endoscopic retrograde cholangiopancreatography; PTC: Percutaneous transhepatic cholangiography; RYHJ: Roux-en-Y hepaticojejunostomy; ABS: Anastomotic biliary stricture.

Table 4 Multivariate analysis of risk factors for biliary complications

Variable	Coefficient	Odds ratio	95%CI	P value
Intercept	-1.581	0.206	0.12-0.35	< 0.001b
Patient age (per 12.1 years)	-0.065	0.937	0.68-1.29	0.688
Donor age (per 15.3 years)	0.093	1.097	0.80-1.51	0.569
Male sex	-0.030	0.971	0.52-1.82	0.926
Cold ischemia time (per 218 minutes)	0.087	1.091	0.78-1.52	0.606
Roux-en-Y reconstruction	-0.748	0.473	0.23-0.97	0.041a
NMP use	0.548	1.729	0.56-5.34	0.341
Hepatic artery thrombosis	-1.408	0.245	0.03-1.87	0.174

^aP < 0.05.

^bP < 0.001.

NMP: Normothermic machine perfusion; CI: Confidence interval.