AI Article Synopsis

  • Bile duct injury (BDI) can occur after gallbladder surgery and may lead to the need for liver transplantation (LT), though it's a rare complication with few large studies available.
  • A systematic review of seven articles involving 179 patients showed that the main reason for LT was secondary biliary cirrhosis (SBC), with significant 30-day mortality rates and notable long-term survival outcomes.
  • Although LT for BDI poses higher short-term risks compared to other conditions, it still offers a potentially effective solution for severe cases.

Article Abstract

Background: Bile duct injury (BDI) is an infrequent but serious complication of cholecystectomy, often with life-changing consequences. Liver transplantation (LT) may be required following severe BDI, however given the rarity, few large studies exist to guide management for complex BDI.

Methods: A systematic review was performed to assess post-operative complications, 30-day mortality, retransplant rate and 1-year and 5-year survival following LT for BDI in Medline, EMBASE, Web of Science or Cochrane Clinical Trials Database.

Results: Seven articles met inclusion criteria, describing 179 patients that underwent LT for BDI. Secondary biliary cirrhosis (SBC) was the main indication for LT (82.2% of patients). Median model for end-stage liver disease (MELD) scores at time of LT ranged from 16 to 20.5. Median 30-day mortality was 20.0%. The 1-year and 5-year survival ranges were 55.0-84.3% and 30.0-83.3% respectively, and the overall retransplant rate was 11.5%.

Conclusion: BDI is rarely indicated for LT, predominantly for SBC following multiple prior interventions. MELD scores poorly reflect underlying morbidity, and exception criteria for waitlisting may avoid prolonged LT waiting times. 30-day mortality was higher than for non-BDI indications, with comparable long term survival, suggesting that LT remains a viable but high risk salvage option for severe BDI.

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Source
http://dx.doi.org/10.1016/j.hpb.2023.08.004DOI Listing

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