Introduction 1 2 3 5 6 The aim of this study is to analyze the incidence of BC after LT, to define their etiological risk factors, and to study the influence of Rh nonidentity on presentation of BC after LT. Materials n n 7 8 9 Statistical analysis P Results Perioperative data and surgical details 3 BCs and Rh mismatch P 1 Table 1 Demographics and Major Complications Occurring in Both Groups Studied, Chi-square Test   n n Chi-square Donor data ABO blood group   0.2  A 25/157 (16%) 132/157 (84%)  B 6/29 (21%) 23/29(79%)  AB 6/19 (32%) 13/19(68%)  O 33/140 (24%) 107/140 (76%) Rh blood group   0.4  Positive 59/301 (19%) 242/301 (81%)  Negative 11/44 (25%) 33/44 (75%) Sex   0.4  Male 51/233 (22%) 182/233 (75%)  Female 19/110 (17%) 91/110 (83%) Donor age   0.4  ≤70 years 66/320 (20%) 254/320 (80%)  >70 years 4/25 (16%) 21/25 (84%) Recipient data Rh blood group   0.2  Positive 54/284 (19%) 230/284 (81%)  Negative 16/61 (26%) 45/61 (74%) Rh D-R crossing   0.1  Positive–positive 45/255 (18%) 210/255 (82%)  Positive–negative 14/46 (30%) 32/46 (70%)  Negative–positive 9/30 (30%) 21/30 (70%)  Negative–negative 2/14 (14%) 12/14 (86%) Rh D-R identity   0.01  Identical 47/269 (17%) 222/269 (83%)  Nonidentical 23/76 (30%) 53/76 (70%) ABO blood group   0.4  A 27/161 (17%) 134/161 (83%)  B 7/34 (20%) 27/34(80%)  O 30/130 (23%) 100/130(77%)  AB 6/20 (30%) 14/20 (70%) ABO D-R identity   0.4  Identical 67/335 (20%) 268/335 (80%)  Nonidentical 3/10 (30%) 7/10 (70%) Sex of recipient   0.4  Male 48/214(22%) 166/214 (78%)  Female 22/130(17%) 108/130(83%) Recipient age   0.2  <60 years 41/221 (18%) 180/221 (82%)  ≥60 years 29/124 (24%) 95/124 (76%) Diagnosis   0.3  Choleostasis 2/14(15%) 12/14(85%)  Cirrhosis 32/162 (20%) 130/162(80%)  Hepatocarcinoma 27/103(26%) 76/103(74%)  Other etiology 1/18(5%) 17/18(95%)  Re-OLT 7/39(18%) 32/39 (89%)  Other tumors 1/9(11%) 8/9 (89%) Surgical data Cold ischemic time   0.01  ≤430 min 26/178 (15%) 148/178 (85%)  >430 min 44/171 (26%) 127/171 (74%) Type of anastomosis   0.6  Termino-terminal 64/315(20%) 251/315(80%) Graft evolution data Arterial thrombosis   0.03  Yes 9/25 (36%) 16/25(64%)  No 60/319 (19%) 259/319(81%) Initial poor function   0.6  Yes 10/43 (23%) 33/43 (77%)  No 60/302 (20%) 242/302 (80%) Primary nonfunction   0.1  Yes 0 8/8 (100%)  No 70/336 (20%) 266/336 (80%) Acute rejection   0.4  Yes 11/66(17%) 55/66(83%)  No 59/279(21%) 220/279(79%) Chronic rejection   0.5  Yes 1/8(12%) 7/8(88%)  No 69/337 (20%) 268/337(80%) OLT Multivariate Analysis of Risk Factors for BCs P P P 2 P 1 P P Table 2 Biliary Complications   Univariate logistic regression Multivariate logistic regression Donor age >70 years 0.5 0.7 Rh D-R identity identical nonidentical 0.01; 2(1.1–3.6) 0.02; 2 (1.1–3.6) Cold ischemic time >430 min 0.01; 1.9(1.1–3.3) 0.02; 1.8(1–3.2) Arterial thrombosis (yes) 0.04; 2.4(1–5.7) 0.02; 2.6 (1.1–6.4) Acute rejection (yes) 0.4 0.4 Chronic rejection (yes) 0.5 0.5 Univariate and multivariate logistic regression. Figure 1 P  Type and Management of BCs BCs were diagnosed in 70 patients. Biliary duct anastomosis stricture was the main complication, presented clinically, with (7/10%) or without postoperative leak (21/30%). Solitary leaks (17/24%), ischemic-type BCs (ITBC) with arterial thrombosis (6/9%), ITBC without arterial thrombosis (10/14%), and lithiasis (9/13%) were also related complications. The therapeutic approach was surgical in 23 patients (33%), endoscopic in 20 (28%), retransplantation in 11 (16%), and conservative treatment in 16 (23%). P P P P P Discussion Etiopathogenesis of BC 10 11 11 12 Relationship Between ABO and Rh in Liver Transplants 6 13 14 6 14 3 6 13 15 16 17 16 6 The nonidentical Rh group has two mismatch possibilities: positive donor to a negative recipient or negative donor to positive recipient. In the first case (positive to negative) the immunologic mechanism is easy to understand because the humoral anti-D (Rh) response may be responsible for the graft injury. 17 In conclusion, Rh-nonidentical LT involves a higher rate of BCs. Future studies should examine the influence of Rh donor and blood group on graft development. Finally, our results suggest that there is a summation effect of BC risk factors. In our opinion, Rh-nonidentical liver grafts should not undergo a very long ischemia time.