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Posttransplant biliary complications in the pre‐ and post‐model for end‐stage liver disease era

Biliary complications remain a cause of morbidity after liver transplantation. The aim of this study was to determine whether changes in clinical practice in the era of the Model for End‐Stage Liver Disease (MELD) has affected biliary complications after liver transplantation. We retrospectively reviewed all deceased donor liver transplants at a single center. Patients were categorized as pre‐ or post‐MELD (transplant before or after February 28, 2002). A total of 1798 recipients underwent deceased donor liver transplants. Biliary stricture was more common in the post‐MELD era (15.4% versus 6.4%, P < 0.001). The strongest risk factors for stricture development were donor age (odds ratio [OR] = 1.01), presence of a prior bile leak (OR = 2.24), use of choledochocholedochostomy (OR = 2.22), and the post‐MELD era (OR = 2.30). Bile leak was more common in the pre‐MELD era (7.5% versus 4.9%, P = 0.02), with use of a T‐tube as the strongest risk factor (OR = 3.38). Surgical factors did not influence the biliary complication rate. In conclusion, even when employing multivariate analysis to allow for factors that may influence biliary strictures, transplant in the post‐MELD era was an independent predictor for stricture development. Further studies are warranted to determine the etiology of this increase. Liver Transpl, 2011. © 2011 AASLD.