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biliary complications in recipients of living donor liver transplantation:A single-centre study

World Journal of Hepatology 2021年第12期13卷 2081-2103页

作者： Reginia Nabil Guirguis Ehab Hasan Nashaat Azza Emam Yassin Wesam Ahmed Ibrahim Shereen A Saleh Mohamed Bahaa Mahmoud El-Meteini Mohamed Fathy Hany Mansour Dabbous Iman Fawzy Montasser Manar Salah Ghada Abdelrahman Mohamed Gastroenterology and Hepatology Unit Department of Internal MedicineFaculty of MedicineAin Shams UniversityCairo 11591Egypt Department of General Surgery Faculty of MedicineAin Shams UniversityCairo 11591Egypt Department of Tropical Medicine Faculty of MedicineAin Shams UniversityCairo 11591Egypt

BACKGROUND biliary complications(BCs)after liver transplantation(LT)remain a considerable cause of morbidity,mortality,increased cost,and graft *** To investigate the impact of BCs on chronic graft rejection,graft failure and *** From 2011 to 2016,215 adult recipients underwent right-lobe living-donor liver transplantation(RT-LDLT)at our *** excluded 46 recipients who met the exclusion criteria,and 169 recipients were included in the final ***’and recipients’demographic data,clinical data,operative details and postoperative course information were *** also reviewed the management and outcomes of *** were followed for at least 12 mo post-LT until December 2017 or graft or patient *** The overall incidence rate of BCs including biliary leakage,biliary infection and biliary stricture was 57.4%.Twenty-seven(16%)patients experienced chronic graft *** failure developed in 20(11.8%)patients.A total of 28(16.6%)deaths occurred during *** were a risk factor for the occurrence of chronic graft rejection and failure;however,mortality was determined by recurrent hepatitis C virus *** biliary complications after RT-LDLT represent an independent risk factor for chronic graft rejection and graft failure;nonetheless,effective management of these complications can improve patient and graft survival.

关键词： biliary complications Living donor liver transplantation Retrospective analysis Bile leak biliary stricture Risk factors Mortality Graft rejection

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biliary complications following liver transplantation: Singlecenter experience over three decades and recent risk factors

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World Journal of Hepatology 2017年第3期9卷 147-154页

作者： Alexander Kaltenborn André Gutcke Jill Gwiasda Jürgen Klempnauer Harald Schrem Department of Trauma and Orthopedic Surgery Federal Armed Forces Hospital Wester-stede Core Facility Quality Management and Health Tech-nology Assessment in Transplantation Integrated Research and Treatment Facility Transplantation (IFB-Tx)Hannover Medical School Department of General Visceral and Transplant Surgery Hannover Medical School

AIM To identify independent risk factors for biliary complications in a center with three decades of experience in liver *** A total of 1607 consecutive liver transplantations were analyzed in a retrospective study. Detailed subset analysis was performed in 417 patients, which have been transplanted since the introduction of Model of End-Stage Liver Disease(MELD)-based liver allocation. Risk factors for the onset of anastomotic biliary complications were identified with multivariable binary logisticregression analyses. The identified risk factors in regression analyses were compiled into a prognostic model. The applicability was evaluated with receiver operating characteristic curve analyses. Furthermore, Kaplan-Meier analyses with the log rank test were applied where appropriate. RESULTS biliary complications were observed in 227 cases(14.1%). Four hundred and seventeen(26%) transplantations were performed after the introduction of MELD-based donor organ allocation. Since then, 21%(n = 89) of the patients suffered from biliary complications, which are further categorized into anastomotic bile leaks [46%(n = 41)], anastomotic strictures [25%(n = 22)], cholangitis [8%(n = 7)] and non-anastomotic strictures [3%(n = 3)]. The remaining 18%(n = 16) were not further classified. After adjustment for all univariably significant variables, the recipient MELD-score at transplantation(P = 0.006; OR = 1.035; 95%CI: 1.010-1.060), the development of hepatic artery thrombosis post-operatively(P = 0.019; OR = 3.543; 95%CI: 1.233-10.178), as well as the donor creatinine prior to explantation(P = 0.010; OR = 1.003; 95%CI: 1.001-1.006) were revealed as independent risk factors for biliary complications. The compilation of these identified risk factors into a prognostic model was shown to have good prognostic abilities in the investigated cohort with an area under the receiver operating curve of *** The parallel occurrence of high recipient MELD and imp

关键词： biliary complications Liver transplantation Prognostic model Risk factors Multivariable analyses

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Single-operator cholangioscopy for biliary complications in liver transplant recipients

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World Journal of Gastroenterology 2017年第22期23卷 4064-4071页

作者： Anna Hüsing-Kabar Hauke Sebastian Heinzow Hartmut Hans-Jürgen Schmidt Carina Stenger Hans Ulrich Gerth Michele Pohlen Gerold Tholking Christian Wilms Iyad Kabar Department of Transplant Medicine University Hospital Muenster Department of Medicine D Division of General Internal MedicineNephrology and RheumatologyUniversity Hospital Muenster Department of Medicine A Hematology and OncologyUniversity Hospital Muenster

To evaluate cholangioscopy in addition to endoscopic retrograde cholangiopancreatography (ERCP) for management of biliary complications after liver transplantation (LT).METHODSTwenty-six LT recipients with duct-to-duct biliary reconstruction who underwent ERCP for suspected biliary complications between April and December 2016 at the university hospital of Muenster were consecutively enrolled in this observational study. After evaluating bile ducts using fluoroscopy, cholangioscopy using a modern digital single-operator cholangioscopy system (SpyGlass DS™) was performed during the same procedure with patients under conscious sedation. All patients received peri-interventional antibiotic prophylaxis and bile was collected during the intervention for microbial analysis and for antibiotic susceptibility ***-three biliary complications were found in a total of 22 patients, whereas four patients showed normal bile ducts. Anastomotic strictures were evident in 14 (53.8%) patients, non-anastomotic strictures in seven (26.9%), biliary cast in three (11.5%), and stones in six (23.1%). A benefit of cholangioscopy was seen in 12 (46.2%) patients. In four of them, cholangioscopy was crucial for selective guidewire placement prior to planned intervention. In six patients, biliary cast and/or stones failed to be diagnosed by ERCP and were only detectable through cholangioscopy. In one case, a bile duct ulcer due to fungal infection was diagnosed by cholangioscopy. In another case, signs of bile duct inflammation caused by acute cholangitis were evident. One patient developed post-interventional cholangitis. No further procedure-related complications occurred. Thirty-seven isolates were found in bile. Sixteen of these were gram-positive (43.2%), 12 (32.4%) were gram-negative bacteria, and Candida species accounted for 24.3% of all isolated microorganisms. Interestingly, only 48.6% of specimens were sensitive to prophylactic ***-operator c

关键词： Cholangioscopy Endoscopic retrograde cholangiopancreatography Liver transplantation biliary complications biliary strictures

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Post-transplant biliary complications using liver grafts from deceased donors older than 70 years:Retrospective case-control study

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World Journal of Gastrointestinal Surgery 2023年第8期15卷 1615-1628页

作者： Carlos Jimenez-Romero Iago Justo-Alonso Pilar del Pozo-Elso Alberto Marcacuzco-Quinto Cristina Martín-Arriscado-Arroba Alejandro Manrique-Municio Jorge Calvo-Pulido Alvaro García-Sesma Ricardo San Román Oscar Caso-Maestro Unit of HPB Surgery and Abdominal Organs Transplantation `12 de Octubre´University HospitalMadrid 28041Spain Clinical Research Unit(I+12) `12 de Octubre´University HospitalMadrid 28041Spain Department of Radiology `12 de Octubre´University HospitalMadrid 28041Spain

BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older *** To determine the incidence,outcomes,and risk factors for biliary complications(BC)in liver transplantation(LT)using liver grafts from donors aged>70 *** Between January 1994 and December 31,2019,297 LTs were performed using donors older than 70 *** excluding 47 LT for several reasons,we divided 250 LTs into two groups,namely post-LT BC(n=21)and without BC(n=229).This retrospective case-control study compared both *** Choledocho-choledochostomy without T-tube was the most frequent technique(76.2%in the BC group vs 92.6%in the non-BC group).Twenty-one patients(8.4%)developed BC(13 anastomotic strictures,7 biliary leakages,and 1 nonanastomotic biliary stricture).Nine patients underwent percutaneous balloon dilation and nine required a Rouxen-Y hepaticojejunostomy because of dilation *** incidence of post-LT complications(graft dysfunction,rejection,renal failure,and non-BC reoperations)was similar in both *** were no significant differences in the patient and graft survival between the ***,only three deaths were attributed to *** female donors were protective factors for BC,donor cardiac arrest was a risk *** The incidence of BC was relatively low on using liver grafts>70 *** could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy,without significant differences in the patient or graft survival between the groups.

关键词： Older liver Liver transplant biliary complications biliary strictures Septuagenarian donors Octogenarian donors

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Impact of biliary complications on quality of life in live-donor liver transplant recipients

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World Journal of Hepatology 2021年第10期13卷 1405-1416页

作者： Reginia Nabil Guirguis Ehab Hasan Nashaat Azza Emam Yassin Wesam Ahmed Ibrahim Shereen A Saleh Mohamed Bahaa Mahmoud El-Meteini Mohamed Fathy Hany Mansour Dabbous Iman Fawzy Montasser Manar Salah Ghada Abdelrahman Mohamed Department of Internal Medicine Gastroenterology and Hepatology UnitFaculty of MedicineAin Shams UniversityCairo 11591Egypt Department of General Surgery Faculty of MedicineAin Shams UniversityCairo 11591Egypt Department of Tropical Medicine Faculty of MedicineAin Shams UniversityCairo 11591Egypt

BACKGROUND Despite significant advancements in liver transplantation(LT)surgical procedures and perioperative care,post-LT biliary complications(BCs)remain a significant source of morbidity,mortality,and graft *** addition,data are conflicting regarding the health-related quality of life(HRQoL)of LT ***,the success of LT should be considered in terms of both the survival and recovery of *** To assess the impact of BCs on the HRQoL of live-donor LT recipients(LDLT-Rs).METHODS We retrospectively analysed data for 25 LDLT-Rs who developed BCs post-LT between January 2011 and December 2016 at our *** Short Form 12 version 2(SF 12v2)health survey was used to assess their *** also included 25 LDLT-Rs without any post-LT complications as a control *** The scores for HRQoL of LDLT-Rs who developed BCs were significantly higher than the norm-based scores in the domains of physical functioning(P=0.003),role-physical(P<0.001),bodily pain(P=0.003),general health(P=0.004),social functioning(P=0.005),role-emotional(P<0.001),and mental health(P<0.001).No significant difference between the two groups regarding vitality was detected(P=1.000).The LDLT-Rs with BCs had significantly lower scores than LDLT-Rs without BCs in all HRQoL domains(P<0.001)and the mental(P<0.001)and physical(P=0.0002)component summary *** The development of BCs in LDLT-Rs causes a lower range of improvement in HRQoL.

关键词： Live-donor liver transplantation Quality of life The Short Form 12 version 2 Cirrhosis biliary complications Mental health

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Role of biliary complications in chronic graft rejection after living donor liver transplantation

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World Journal of Hepatology 2022年第5期14卷 1050-1052页

作者： Aiman Obed Abdalla Bashir Anwar Jarrad Laszlo Fuzesi Hepatobiliary and Liver Transplant Unit Jordan HospitalAmman 52112Jordan Department of General Surgery Jordan HospitalAmman 52112Jordan Department of Hepatology Jordan HospitalAmman 52112Jordan Department of Pathology Faculty of MedicineUniversity AugsburgAugsburg 86156Germany

Postoperative biliary complications remain a substantial challenge after living donor liver transplantation,especially due to its heterogeneous clinical presentation.

关键词： Chronic graft rejection biliary complications Living donor liver transplantation Graft survival Cholangiopathy

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T-tube vs no T-tube for biliary tract reconstruction in adult orthotopic liver transplantation:An updated systematic review and metaanalysis

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World Journal of Gastroenterology 2021年第14期27卷 1507-1523页

作者： Jun-Zhou Zhao Lin-Lan Qiao Zhao-Qing Du Jia Zhang Meng-Zhou Wang Tao Wang Wu-Ming Liu Lin Zhang Jian Dong Zheng Wu Rong-Qian Wu Department of Hepatobiliary Surgery First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina

BACKGROUND Whether to use a T-tube for biliary anastomosis during orthotopic liver transplantation(OLT)remains a debatable *** surgeons chose to use a T-tube because they believed that it reduces the incidence of biliary *** in surgical techniques during the last decades have significantly decreased the overall incidence of postoperative biliary *** using a T-tube during OLT is still associated with the reduced incidence of biliary strictures needs to be *** To provide an updated systematic review and meta-analysis on using a T-tube during adult *** In the electronic databases MEDLINE,PubMed,Scopus,***,the Cochrane Library,the Cochrane Hepato-biliary Group Controlled Trails Register,and the Cochrane Central Register of Controlled Trials,we identified 17 studies(eight randomized controlled trials and nine comparative studies)from January 1995 to October *** data of the studies before and after 2010 were separately *** chose the overall biliary complications,bile leaks or fistulas,biliary strictures(anastomotic or non-anastomotic),and cholangitis as *** ratios(ORs)with 95%confidence intervals(CIs)were calculated to describe the results of the ***,the test for overall effect(Z)was used to test the difference between OR and 1,where P≤0.05 indicated a significant difference between OR value and *** A total of 1053 subjects before 2010 and 1346 subjects after 2010 were included in this *** pooled results showed that using a T-tube reduced the incidence of postoperative biliary strictures in studies before 2010(P=0.012,OR=0.62,95%CI:0.42-0.90),while the same benefit was not seen in studies after 2010(P=0.60,OR=0.76,95%CI:0.27-2.12).No significant difference in the incidence of overall biliary complications(P=0.37,OR=1.41,95%CI:0.66-2.98),bile leaks(P=0.89,OR=1.04,95%CI:0.63-1.70),and cholangitis(P=0.27,OR=2.00,95%CI:0.59-6.84)was obse

关键词： Orthotopic liver transplantation T-tube biliary tract reconstruction biliary complications biliary strictures Meta-analysis

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Aetiology and risk factors of ischaemic cholangiopathy after liver transplantation

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World Journal of Gastroenterology 2014年第20期20卷 6159-6169页

作者： Moustafa Mabrouk Mourad Abdullah Algarni Christos Liossis Simon R Bramhall Liver Unit Queen Elizabeth Hospital Birmingham B15 2TH United Kingdom

Liver transplantation (LT) is the best treatment for end-stage hepatic failure, with an excellent survival rates over the last decade. biliary complications after LT pose a major challenge especially with the increasing number of procured organs after circulatory death. Ischaemic cholangiopathy (IC) is a set of disorders characterized by multiple diffuse strictures affecting the graft biliary system in the absence of hepatic artery thrombosis or stenosis. It commonly presents with cholestasis and cholangitis resulting in higher readmission rates, longer length of stay, repeated therapeutic interventions, and eventually re-transplantation with consequent effects on the patient’s quality of life and increased health care costs. The pathogenesis of IC is unclear and exhibits a higher prevalence with prolonged ischaemia time, donation after circulatory death (DCD), rejection, and cytomegalovirus infection. The majority of IC occurs within 12 mo after LT. Prolonged warm ischaemic times predispose to a profound injury with a subsequently higher prevalence of IC. biliary complications and IC rates are between 16% and 29% in DCD grafts compared to between 3% and 17% in donation after brain death (DBD) grafts. The majority of ischaemic biliary lesions occur within 30 d in DCD compared to 90 d in DBD grafts following transplantation. However, there are many other risk factors for IC that should be considered. The benefits of DCD in expanding the donor pool are hindered by the higher incidence of IC with increased rates of re-transplantation. Careful donor selection and procurement might help to optimize the utilization of DCD grafts.

关键词： Ischaemic cholangiopathy biliary complications Orthotopic liver transplantation Donation after circulatory death Reperfusion injury Cold ischaemia time

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Impact of cytomegalovirus infection on biliary disease after liver transplantation-maybe an essential factor

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World Journal of Clinical Cases 2021年第35期9卷 10792-10804页

作者： Jing-Yi Liu Jian-Rui Zhang Li-Ying Sun Zhi-Jun Zhu Lin Wei Wei Qu Zhi-Gui Zeng Ying Liu Xin-Yan Zhao Liver Transplantation Center Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China Clinical Center for Pediatric Liver Transplantation Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China National Clinical Research Center for Digestive Diseases Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China Intensive Care Unit Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND Cytomegalovirus(CMV)infection is common in liver transplant(LT)_recipients,and biliary complications occur in a large number of *** has been reported that CMV-DNA is more detectable in bile than in *** To investigate the effects of CMV infection on biliary complications by comparing the levels of CMV-DNA in the bile and blood of patients after *** We conducted a retrospective analysis of 57 patients who underwent LT,10 of these patients had no biliary complications and 47 patients had biliary *** also compared the levels of CMV-DNA in patients’bile and blood,which were sampled *** used RNAscope technology to identify CMV in paraffin-embedded liver *** CMV-DNA was not detected in bile samples and was detected in 2 blood samples from patients without biliary *** the 47 patients with biliary complications,CMV-DNA was detected in 22 bile samples and 8 blood samples,both bile and blood samples were positive for CMV-DNA in 6 *** identification rate of CMV-DNA in blood was 17.0%,and was 46.8%in ***,tissue samples from 4 patients with biliary complications tested positive using RNAscope technology but were negative with hematoxylin and eosin *** the follow-up period,graft failure occurred in 13 patients with biliary complications,8 of whom underwent retransplantation,and 3 ***-DNA in bile was detected in 9 of 13 patients with graft *** In patients with biliary complications,the identification rate of CMV-DNA in bile was higher than that in *** CMV-DNA negative patients with biliary complications should still be monitored for CMV-related biliary tract *** occult CMV infection may also be a contributing etiological factor in the development of graft failure.

关键词： Liver transplantation Cytomegalovirus infection Graft failure biliary complications RNAscope in situ hybridization Retrospective study

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Optimizing biliary outcomes in living donor liver transplantation:Evolution towards standardization in a high-volume center

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Hepatobiliary & Pancreatic Diseases International 2020年第4期19卷 324-327页

作者： Tsan-Shiun Lin Jeffrey Samuel Co Chao-Long Chen Aldwin D.Ong Liver Transplantation Center Department of SurgeryKaohsiung Chang Gung Memorial Hospital123 Ta-Pei RoadNiao SungKaohsiung 833TaiwanChina

biliary complications have always been a dreaded cause of morbidity after living donor liver *** intrinsic variations in both graft and recipient biliary anatomy remain a significant factor to the difficulty of biliary reconstruction,our institution has taken advantage of its high volume of cases to critically review and evaluate modifiable operative risk factors,in particular,our surgical *** present herein,the evolution of our reconstructive biliary technique from conventional methods to our current standard of microsurgical biliary reconstruction for both graft and recipient *** this period of transition,our center has created a classification system for biliary reconstruction that decreased the biliary complication rates from 40.0%to 10.2%.

关键词： Living donor liver transplantation biliary reconstruction Microsurgical biliary reconstruction biliary classification biliary complications

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