Raised pressure in the bile ducts after orthotopic liver transplantation

Biliary complications are common after orthotopic liver transplantation. Bile leakage in the immediate postoperative period and on removal of the T-tube could possibly be caused by a raised bile duct pressure. In order to test this hypothesis, bile duct pressure was studied in seven consecutive liver transplant patients. During the operation, the common bile duct was anastomosed end-to-end over a T-tube. The initial bile duct pressure measurement was performed a median of 12 days (range 10–17 days) after the transplantation and on one or two more occasions during the following 3 months. Seven cholecystectomized gallstone patients with indwelling T-tubes were used as controls. The bile duct pressure at the level of the xiphoid process in the transplanted group was 7.7±1.4 cm H2O and in the control group 0.5±0.8 cm H2O (P<0.001). The initially increased bile duct pressure after liver transplantation decreased with time (P<0.05) towards normal during the following 3 months. The raised pressure may increase the risk of bile leakage in the postoperative period.