Biliary Complications after Liver Transplantation in the United States: Changing Trends and Economic Implications

Priyadarshini Manay, Abhinav Seth, Kyle Jackson, Krista L. Lentine, Mark A. Schnitzler, Huiling Xiao, Dorry L. Segev, David A. Axelrod

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


BACKGROUND: Biliary complications (BCs) continue to impact patient and graft survival after liver transplant (LT), despite improvements in organ preservation, surgical technique, and posttransplant care. Real-world evidence provides a national estimate of the incidence of BC after LT, implications for patient and graft outcomes, and attributable cost not available in transplant registry data.

METHODS: An administrative health claims-based BC identification algorithm was validated using electronic health records (N = 128) and then applied to nationally linked Medicare and transplant registry claims.

RESULTS: The real-world evidence algorithm identified 97% of BCs in the electronic health record review. Nationally, the incidence of BCs within 1 y of LT appears to have improved from 22.2% in 2002 to 20.8% in 2018. Factors associated with BCs include donor type (living versus deceased), recipient age, diagnosis, prior transplant, donor age, and donor cause of death. BCs increased the risk-adjusted hazard ratio (aHR) for posttransplant death (aHR, 1.43; P  < 0.0001) and graft loss (aHR, 1.48; P  < 0.0001). Nationally, BCs requiring intervention increased risk-adjusted first-year Medicare spending by $39 710 ( P  < 0.0001).

CONCLUSIONS: BCs remain an important cause of morbidity and expense after LT and would benefit from a systematic quality-improvement program.

Original languageEnglish (US)
Pages (from-to)E127-E138
Issue number5
StatePublished - May 1 2023


  • Aged
  • Graft Survival
  • Humans
  • Liver Transplantation/methods
  • Medicare
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Tissue Donors
  • Treatment Outcome
  • United States/epidemiology


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