Impacts of spleen volume and collateral circulation on the biliary complications in patients with hepatic cirrhosis after liver transplantation

  Objective   To investigate the impacts of spleen volume and collateral circulation on the biliary complications in patients with end-stage hepatic cirrhosis after liver transplantation(LT).

  Method   Seventy-four patients who underwent LT in the Third Affiliated Hospital of Sun Yat-sen University from April 2005 to February 2013 were enrolled in this study. All the patients received computed tomography (CT) and/or magnetic resonance imaging (MRI) before and after LT. The patients were divided into 3 groups according to the changes of spleen volume after LT: group A (the volume reduced to the normal range), group B (the volume reduced but still exceeded the normal range), group C (the volume increased). Twenty healthy people were enrolled in the study as the normal control group. The spleen form and diameter changes of splenic vein, portal vein before and after operation in 3 groups were counted and compared with that in normal control group. The establishment of collateral circulation before and after operation and postoperative follow-up of patients in 3 groups were recorded.

  Result   There were 18 cases(24%) in group A, 39 cases (53%) in group B, 17 cases(23%)in group C. The collateral circulation was obviously relieved after operation for patients in group A and group B, but it was not relieved and became worse for patients in group C. Six cases (33%) in group A suffered from mild vascular complications after LT and 1 case (6%) suffered from mild ischemic cholangitis after LT. Seventeen cases (44%) in group B suffered from mild vascular complications after LT and 6 cases(15%) suffered from mild ischemic cholangitis after LT. Seventeen cases (100%) in group C suffered from severe vascular complications after LT with biliary complications of different degrees and granulation tissues were found in hepatic hilar area of 5 cases.

  Conclusion   The incidence of biliary complications in patients with end stage hepatic cirrhosis and portal hypertension after LT is comparatively high. The abnormal hemodynamics caused by severe vascular complications after LT is one of the influences.