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High incidence of biliary complications in rat liver transplantation:Can we avoid it?

World Journal of Gastroenterology 2011年第26期17卷 3140-3144页

作者： Guo-Lin Li Li-Hong Lv Jian-Dong Yu Yong-Heng Huang Jun Min Hao-Ming Lin Yun-Le Wan Tian-Zhu Long Department of Hepa-tobiliary Surgery Sun Yat-sen Memorial Hospital Sun Yat-senUniversity Haizhu District Guangzhou 510260 GuangdongProvince China Department of Breast Surgery GuangzholWomen and Children＇s Medical Center Guangzhou 510260Guangdong Province China

MM： To investigate how to reduce the incidence of biliary complications in rat orthotopic liver transplantation. METHODS： A total of 165 male Wistar rats were ran- domly divided into three groups： Group A, orthotropic liver transplantation with modified ＂two-cuff＂ technique; Group B, bile duct was cut and reconstructed without transplantation; and Group C, only laparotomy was performed. Based on the approaches used for biliary reconstruction, Group A was divided into two sub-groups： A1 （n = 30）, duct-duct reconstruction, and A2 （n = 30）, duct-duodenum reconstruction. To study the influence of artery reconstruction on bile duct complication, Group B was divided into four sub-groups： B1 （n = 10）, duct-duct reconstruction with hepatic artery ligation, B2 （n = 10）, duct-duct reconstruction without hepatic artery ligation, B3 （n = 10）, duct-duodenum reconstruction with hepatic artery ligation, and B4 （n = 10）, duct-duodenum recon- struction without hepatic artery ligation. The samples were harvested 14 d after operation or at the time when significant biliary complication was found. RESULTS： In Group A, the anhepatic phase was 13.7 ＋ 1.06 min, and cold ischemia time was 50.5 ＋ 8.6 min. There was no significant difference between A1 and A2 in the operation duration. The time for biliary reconstruction was almost the same among all groups. The success rate for transplantation was 98.3% （59/60）. Significant differ- ences were found in the incidence of biliary complications in Groups A （41.7%）, B （27.5%） and C （0%）. A2 was more likely to have biliary complications than A1 （50% vs 33.3%）. B3 had the highest incidence of biliary complica- tions in Group B. CONCLUSION： biliary complications are almost in- evitable using the classical ＂two cuff＂ techniques, and duct-duodenum reconstruction is not an ideal option in rat orthotopic liver transplantation.

关键词： Rat Liver transplantation biliary complication Animal model

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Advances in endoscopic management of biliary complications after living donor liver transplantation: Comprehensive review of the literature

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World Journal of Gastroenterology 2016年第27期22卷 6173-6191页

作者： Milljae Shin Jae-Won Joh Department of Surgery Konkuk University Medical Center Konkuk University School of Medicine Department of Surgery Samsung Medical Center Sungkyunkwan University School of Medicine

Apart from noticeable improvements in surgical techniques and immunosuppressive agents, biliary complications remain the major causes of morbidity and mortality after living donor liver transplantation(LDLT). Bile leakage and stricture are the predominant complications. The reported incidence of biliary complications is 15%-40%, and these are known to occur more frequently in living donors than in deceased donors. Despite the absence of a confirmed therapeutic algorithm, many approaches have been used for treatment, including surgical, endoscopic, and percutaneous transhepatic techniques. In recent years, nonsurgical approaches have largely replaced reoperation. Among these, the endoscopic approach is currently the preferred initial treatment for patients who undergo duct-to-duct biliary reconstruction. Previously, endoscopic management was achieved most optimally through balloon dilatation and single or multiple stents placement. Recently, there have been significant developments in endoscopic devices, such as novel biliary stents, as well as advances in endoscopic technologies, including deep enteroscopy, the rendezvous technique, magnetic compression anastomosis, and direct cholangioscopy. These developments have resulted in almost all patients being managed by the endoscopic approach. Multiple recent publications suggest superior long-term results, with overall success rates ranging from 58% to 75%. This article summarizes the advances in endoscopic management of patients with biliary complications after LDLT.

关键词： biliary complication Endoscopic retrograde cholangiography Endoscopic management Living donor Liver transplantation

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Endoscopic treatment of biliary complications after liver transplantation

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World Journal of Gastroenterology 2008年第26期14卷 4185-4189页

作者： Ilaria Tarantino Luca Barresi Ioannis Petridis Riccardo Volpes Mario Traina Bruno Gridelli Department of Gastroenterology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT)University of Pittsburgh Medical Center (UPMC)Palermo 90100Italy Department of Surgery Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT)University of Pittsburgh Medical CenterPalermo 90100Italy

AIM： To evaluate the efficacy of endoscopic treatment in patients who undergo OLTx or LRLTx and develop biliary complications. METHODS： This is a prospective, observational study of patients who developed biliary complications, after OLTx and LRLTx, with duct-to-duct anastomosis performed between June 2003 and June 2007. Endoscopic Retrograde Cholangiopancreatography （ERCP） was considered unsuccessful when there was evidence of continuous bile leakage despite endoscopic stent placement, or persistence of stenosis after i year, despite multiple dilatation and stent placement. When the ERCP failed, a percutaneous trans-hepatic approach （PTC） or surgery was adopted. RESULTS： From June 2003 to June 2007, 261 adult patients were transplanted in our institute, 68 from living donors and 193 from cadaveric donors. In the OLTx group the rate of complications was 37.3%, while in the LRLTx group was 64.7%. The rate of ERCP failure was 19.4% in the OLTx group and 38.6% in LRLTx group. In OLTx group, i patient was retransplanted and 8 patients died. In the LRLTx group, 2 patients underwent OLTx and 8 patients died. The follow-up was 23.3±13.13 mo and 21.02± 14.10 mo, ***： Albhough ERCP is quite an effective mode of managing post-transplant bile duct complications, a significant number of patients need other types of approach. Further prospective studies are necessary in order to establish whebher obher endoscopic protocols or new devices, could improve bhe current results.

关键词： Endoscopic retrograde cholangiopancreatography biliary complication Liver transplant Benignstenosis biliary leak

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Gastroduodenal artery disconnection during liver transplantation decreases non-anastomotic stricture incidence

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Hepatobiliary & Pancreatic Diseases International 2023年第1期22卷 28-33页

作者： Bi Pan Wei Liu Yan-Jiao Ou Yan-Qi Zhang Di Jiang Yuan-Cheng Li Zhi-Yu Chen Lei-Da Zhang Cheng-Cheng Zhang Department of Hepatobiliary Surgery Southwest HospitalThird Military Medical University(Army Medical University)Chongqing 400038China Department of Health Statistics College of Military Preventive MedicineThird Military Medical University(Army Medical University)Chongqing 400038China

Background:The hepatic artery is the only blood source nourishing the biliary duct and associated with biliary complication after liver transplantation(LT).Gastroduodenal artery(GDA)disconnection increased proper hepatic artery *** this procedure attenuates biliary non-anastomotic stricture(NAS)is not ***:A total of 241 patients with LT were retrospectively *** patients were divided into the GDA disconnection(GDA-)and GDA preservation(GDA+)*** score matching(PSM)was administrated to reduce *** regression was conducted to analyze risk factors for biliary NAS before and after *** complications were ***-Meier survival analysis and log-rank tests were performed to compare overall ***:In all,99 patients(41.1%)underwent GDA disconnection,and 49(20.3%)developed *** logistic regression revealed that GDA preservation(OR=2.24,95%CI:1.11-4.53;P=0.025)and model for end-stage liver disease(MELD)score>15(OR=2.14,95%CI:1.12-4.11;P=0.022)were risk factors for biliary *** provided 66 pairs using 1:2 matching method,including 66 GDA disconnection and 99 GDA preservation *** logistic regression after PSM also showed that GDA preservation(OR=3.15,95%CI:1.26-7.89;P=0.014)and MELD score>15(OR=2.41,95%CI:1.08-5.36;P=0.031)were risk factors for *** comparing complications between the two groups,GDA preservation was associated with a higher incidence of biliary NAS before and after PSM(P=0.031 and 0.017,respectively).In contrast,other complications including early allograft dysfunction(P=0.620),small-for-size graft syndrome(P=0.441),abdominal hemorrhage(P=1.000),major complications(Clavien-Dindo grade≥3,P=0.318),and overall survival(P=0.088)were not significantly different between the two ***:GDA disconnection during LT ameliorates biliary NAS incidence and may be recommended for application in clinical practice.

关键词： Liver transplantation biliary complication Gastroduodenal artery disconnection Hepatic artery hyperperfusion

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Establishment of an animal model of ischemic type intrahepatic biliary lesion in rabbits

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World Journal of Gastroenterology 2009年第6期15卷 732-736页

作者： Qin-song Sheng Da-Zhi Chen Ren Lang Qiang He Yong-Jiu Yang Zhao-Wei Qu De-Fang Zhao Xiao-Sheng Zhang Department of Hepatobiliary and Pancreatosplenic Surgery Beijing Chaoyang Hospital affiliated to the Capital Medical University Beijing 100020 China

AIM:To explore a method to establish an animal model of ischemic type intrahepatic biliary lesion in rabbits. METHODS:Forty Japanese white rabbits of clean grade were divided randomly into four groups(10 rabbits per group)including sham operation(SO) group,and artery-bile obstruction(ABO)-1 h group, ABO-2 h group and ABO-3 h *** the rabbits in this study underwent the same initial surgical procedure in which the liver was prepared as for graft removal during liver *** in the SO group,no additional vascular intervention was performed,while in groups ABO-1 h,ABO-2 h and ABO-3 h,the animals underwent combined clamping of the hepatic artery and common bile duct with microvascular clips for 1,2 and 3 h,*** the scheduled occlusion time,the clip was removed to recover blood *** animals were killed 4 wk after *** survival rate,liver function, cholangiography and histopathological manifestation of the rabbits in each group were observed. RESULTS:The survival rate was 100%in groups SO,ABO-1 h and ABO-2 h,while it was 60%in group ABO-3 *** each observation time,the change degree of the indexes of liver function was proportional to the clamping time(ABO-3 h>ABO-2 h>ABO-1 h> SO,Pbiliary lesion aggravated proportionally with the increase of the clamping time. CONCLUSION:An animal model of ischemic type intrahepatic biliary lesion in rabbits is successfully established,which may provide a reliable technique for basic and clinical research into the etiology, development and prophylaxis of ischemic type intrahepatic biliary lesion after liver transplantation.

关键词： biliary complication Ischemic type biliary lesion Animal model Liver transplantation Intrahepatic biliary stricture Ischemic reperfusion injury

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Management of biliary complications after liver transplantation

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World Journal of Hepatology 2015年第29期7卷 2890-2895页

作者： Riccardo Memeo Tullio Piardi Federico Sangiuolo Daniele Sommacale Patrick Pessaux Hepato-biliary and Pancreatic Surgical Unit GeneralDigestive and Endocrine SurgeryIRCADIHU Mix-SurgInstitute for Minimally Invasive Image-Guided SurgeryUniversity of Strasbourg1 place de l’Hopital Department of General Digestive and Endocrine SurgeryHopital Robert DebréCentre Hospitalier Universitaire de ReimsUniversitéde Reims Champagne-Ardenne

biliary complications(BC) currently represent a major source of morbidity after liver transplantation. Although refinements in surgical technique and medical therapy have had a positive influence on the reduction of postoperative morbidity, BC affect 5% to 25% of transplanted patients. Bile leak and anastomotic strictures represent the most common complications. Nowadays, a multidisciplinary approach is required to manage such complications in order to prevent liver failure and retransplantation.

关键词： biliary complication Bile leak Anastomotic stricture Endoscopic treatment Liver transplantation

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Impact of pure laparoscopic surgery on bile duct division of living donor left lateral section procurement

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Hepatobiliary Surgery and Nutrition 2023年第3期12卷 328-340,I0008-I0011页

作者： Hai-Ming Zhang Lin Wei Hong-Yu Li Li-Ying Sun Wei Qu Zhi-Gui Zeng Ying Liu Zhi-Jun Zhu Beijing Friendship Hospital Capital Medical UniversityBeijingChina Clinical Center for Pediatric Liver Transplantation Capital Medical UniversityBeijingChina National Clinical Research Center for Digestive Diseases BeijingChina

Background:Although laparoscopic living donor left lateral section liver procurements represents an established and safe procedure,there remains much discussion on this *** particular,the issue of whether laparoscopic living donor liver procurement increases the difficulty of the surgery and potential complications for recipients continue to confound experts in this ***:In this report,data from 180 cases of living donor left lateral section liver transplantation patients were analyzed *** these 180 cases,106 grafts were procured by open surgery and 74 by pure laparoscopic ***:While surgery durations and blood loss were decreased in donors from the laparoscopic surgery group,increased biliary openings of grafts and relatively high peak aspartate aminotransferase(AST)levels were present in both donors and recipients with this ***:Laparoscopic living donor left lateral section liver procurement represents a safe and effective procedure for both donors and ***,laparoscopic surgery can more frequently lead to multiple biliary tracts in the graft and its impact on the prognosis of recipients remains *** of routine X-ray based intraoperative cholangiography may help to reduce this problem.

关键词： Pure laparoscopic surgery living donor liver transplantation(LDLT) biliary complication prognosis

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Early prevention and treatment of biliary tract complications after orthotopic liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2003年第1期2卷 48-53页

作者： Jing-Wang Tan Yi Jiang He-Xiang Yao Li-Zhi Lu Shao-Geng Zhang the Department of Hepatobiliary Surgery,Fuzhou General Hospital,Fuzhou 350025,China Department of Hepatobiliary Surgery Fuzhou General Hospital Fuzhou 35 0025 China. tanjingwang8@***

OBJECTIVE: To investigate the prevention and treatment of biliary complications after orthotopic liver transplantation (OLT). METHODS: OLT was performed in 18 patients with end-stage liver disease, including 6 patients with primary liver cancer. Except 1 patient was infused only through the portal vein, others were infused through the portal vein and hepatic artery of the donor. The biliary tract was reconstructed using choledochocholedostomic anastomosis in 17 patients, and using Roux-en-Y choledochojejunostomic anastomosis in 1 patient. RESULTS: Four patients with biliary complication were found. In one patient, biliary leakage was found around the T-tube on day 14 postoperatively, and disappeared after re-opening of the tube. In one patient undergoing Roux-en-Y choledochojejunostomic anastomosis, biliary leakage was found on day 12 postoperatively and reoperation was performed. The T-tube was removed from the anastomosis after reoperation, and abdominal infection was controlled, but high fever recurred on day 49 postoperatively. The patient died on day 52 postoperatively. Autopsy revealed biliary leakage and biliary tract necrosis. In another patient, biliary leakage was found on day 3 after operation, and was treated by adequate drainage. Four months after operation, biliary sludge in the common tract was found and treated successfully with oral chemolysis. But biliary sludge or stone recur on one and half year after OLT. Spincterotomy and basket extraction were performed via endoscopic retrograde cholangiopancreatography, and the biliary sludge or stone was cleared out. In case 4, biliary drainage tube cholangiogram showed anastomotic stenosis one month after operation. Three months later, biliary sludge or stone was found beyond anastomotic stenosis. After oral chemolysis (ursodeoxycholic acid) and irrigation with heparinized saline solution via the biliary drainage tube, the biliary sludge disappeared. CONCLUSIONS: To reduce the incidence of biliary complicat

关键词： orthotopic liver transplantation biliary complication treatment prevention

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Current status and perspective of liver preservation solutions

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Hepatobiliary & Pancreatic Diseases International 2006年第4期5卷 490-494页

作者： Xiao-Ning Feng, Xiao Xu and Shu-Sen Zheng Department of Hepatobiliary Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China Department of Hepatobiliary Surgery First Affiliated Hospital Zhejiang University School of Medicine Hangzhou 310003 China.

BACKGROUND: A safe and effective preservation solution is a precondition for liver transplantation, which is accepted as the radical treatment for patients with end- stage liver disease. The increasing use of marginal donors and non-heart beating donors as well as the establishment of a national organ allocation network call for better preservation. New preservation solutions like histidine- tryptophan-ketoglutarate (HTK) solution and Celsior solution have been introduced to liver preservation, and protective gene intervention and other modifications have also been investigated. In this article, we review recent advances in liver preservation solutions. DATA SOURCES: An English-language literature search was conducted using MEDLINE (1990-2005) on liver preservation solution, biliary complication, protective gene and other related subjects. RESULTS: Although the high viscosity of the University of Wisconsin (UW) solution proved harmful to the hepatic microcirculation, three solutions showed equivalent preservation effects. When the cold ischemia time was short, there were no significant differences among the three solutions in the incidence of biliary complications. So far, modifications of preservation solutions have achieved great success. Several types of protective genes like A20, Bcl-2, Bcl-XL and HO-1 were reported to have definite liver protective effects. The addition of other substrates like TNF-α antibody, tacrolimus (FK506) and fructose-1, 6-bisphosphate (FBP) can also improve the preservation effect. However, addition of insulin to UW solution is harmful to the graft. CONCLUSIONS: In centers with highly-developed transplantation techniques, HTK and Celsior solutions are acceptable in liver preservation. Protective genemodification and addition of substrates like TNF-α antibody, FK506 and FBP are prominent approaches to improve liver preservation.

关键词： liver preservation solution biliary complication protective gene microcirculation

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Mucocele formation of cystic bile duct remnant after orthotopic liver transplantation

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Chinese Medical Journal 2007年第3期120卷 254-256页

作者： LIANG Ting-bo ZHAO Zhi-cheng JIA Chang-ku ZHENG Shu-sen Department of Hepatobiliary Pancreatic Surgery Key Laboratory of Combined Mulfiorgan Transplantation Ministry of Public Health First Affiliated Hospital of Medical College Zhejiang University Hangzhou 310003 China

Liver transplantation （LT） has become a common ＇method for end-stage liver disease. Although the incidence of biliary complications after LT has decreased to 8% to 20% in recent years, it is still one of the main factors affecting the life quality and long-term survival of recipients. As an uncommon complication, the mucocele formation of cystic duct remnant may compress or obstruct the common hepatic duct and result in injury to the liver graft.

关键词： liver transplantation biliary complication mucocele cystic duct remnant

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