Bile duct strictures after liver transplantation

Pascher, Andreas; Gerlach, Undine; Neuhaus, P.

doi:10.1097/mog.0000000000000061

Cited by 17 publications

(7 citation statements)

References 35 publications

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“…Neben dem Anspruch der Verbesserung der operativen Therapie durch EUROCRINE ® -basierte klinische Forschung kann die Datenbank durch die teilnehmenden Kliniken für ein individuelles Benchmarking genutzt werden, welches durch einen zeitlich unabhängig durchführbaren Datenexport in Microsoft Excel oder Microsoft PowerBI ermöglicht wird [21].…”

Section: Ausblickunclassified

EUROCRINE®: Nebennierenoperationen 2015 bis 2019 – überraschende erste Ergebnisse

Staubitz

Clérici

Riss

et al. 2020

Chirurg

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Zusammenfassung Hintergrund Seit 2015 erfolgt in Europa mithilfe des EUROCRINE®-Registers eine systematische Dokumentation endokrin-chirurgischer Operationen. Ziel dieser ersten Auswertung war eine Darstellung der Versorgungsrealität für Nebenniereneingriffe in einem homogenen Versorgungsumfeld, entsprechend des deutschsprachigen Raums – bzw. des Präsenzgebiets der Chirurgischen Arbeitsgemeinschaft Endokrinologie (CAEK) der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) – einschließlich einer Analyse der Adhärenz zu geltenden Therapieempfehlungen. Methodik Es erfolgte eine deskriptive Analyse der präoperativen Diagnostik, der angewandten Operationstechniken sowie der zugrunde liegenden histologischen Entitäten der zwischen den Jahren 2015 und 2019 über EUROCRINE® in Deutschland, Österreich und der Schweiz dokumentierten Nebennierenoperationen. Ergebnisse In den insgesamt 21 teilnehmenden Kliniken des deutschsprachigen EUROCRINE®-Gebiets wurden 658 Operationen an Nebennieren durchgeführt. In 90 % erfolgten unilaterale, in 3 % bilaterale Adrenalektomien und in 7 % andere Resektionsverfahren. Die in 41 % der Operationen dokumentierte histologische Hauptdiagnose war das adrenokortikale Adenom. In 15 % lagen maligne Befunde zugrunde (einschließlich 6 % Nebennierenrindenkarzinome (ACC) und 8 % Nebennierenmetastasen). 23 % der Operationen erfolgten bei Phäochromozytomen. Diese wurden zu 82 % minimal-invasiv operiert, Nebennierenrindenkarzinome lediglich zu 28 % und Nebennierenmetastasen zu 66 %. Schlussfolgerung Überraschenderweise wurden nach Nebennierenadenomen und Phäochromozytomen an dritthäufigster Stelle Nebennierenmetastasen unterschiedlicher Primärtumoren reseziert. 28 % der ACC waren für minimal-invasive Techniken vorgesehen, wobei 20 % dieser Fälle eine Konversion zur offenen Operation erforderten. Die aktuelle Analyse deckte Diskrepanzen zwischen Versorgungsrealität und Leitlinienempfehlungen auf, aus denen sich zahlreiche Fragestellungen ergeben, welche nun in ein überarbeitetes EUROCRINE®-Modul zur Dokumentation von Nebennierenoperationen einfließen werden.

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Section: Ausblickunclassified

EUROCRINE®: Nebennierenoperationen 2015 bis 2019 – überraschende erste Ergebnisse

Staubitz

Clérici

Riss

et al. 2020

Chirurg

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“…However, other causes of cholestatic jaundice, such as graft rejection (acute or chronic), recurrence of primary disease (hepatitis B/C), fibrosing cholestatic hepatitis C, sepsis or drug-induced cholestasis[ 46 ], make the diagnosis of biliary strictures particularly challenging[ 52 ]. A high index of suspicion is warranted in such patients, especially since they rarely have abdominal pain due to hepatic denervation and immunosuppressants[ 53 - 55 ]. The diagnostic protocol practised in most centres involves a composite approach with clinical features, laboratory evaluation, imaging studies and liver biopsy.…”

Section: Biliary Strictures Complicating Ldltmentioning

confidence: 99%

Biliary strictures complicating living donor liver transplantation: Problems, novel insights and solutions

Rao

Prakash

Sudhindran

et al. 2018

WJG

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Biliary stricture complicating living donor liver transplantation (LDLT) is a relatively common complication, occurring in most transplant centres across the world. Cases of biliary strictures are more common in LDLT than in deceased donor liver transplantation. Endoscopic management is the mainstay for biliary strictures complicating LDLT and includes endoscopic retrograde cholangiography, sphincterotomy and stent placement (with or without balloon dilatation). The efficacy and safety profiles as well as outcomes of endoscopic management of biliary strictures complicating LDLT is an area that needs to be viewed in isolation, owing to its unique set of problems and attending complications; as such, it merits a tailored approach, which is yet to be well established. The diagnostic criteria applied to these strictures are not uniform and are over-reliant on imaging studies showing an anastomotic narrowing. It has to be kept in mind that in the setting of LDLT, a subjective anastomotic narrowing is present in most cases due to a mismatch in ductal diameters. However, whether this narrowing results in a functionally significant narrowing is a question that needs further study. In addition, wide variation in the endotherapy protocols practised in most centres makes it difficult to interpret the results and hampers our understanding of this topic. The outcome definition for endotherapy is also heterogenous and needs to be standardised to allow for comparison of data in this regard and establish a clinical practice guideline. There have been multiple studies in this area in the last 2 years, with novel findings that have provided solutions to some of these issues. This review endeavours to incorporate these new findings into the wider understanding of endotherapy for biliary strictures complicating LDLT, with specific emphasis on diagnosis of strictures in the LDLT setting, endotherapy protocols and outcome definitions. An attempt is made to present the best management options currently available as well as directions for future research in the area.

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“…Anastomotic biliary strictures (AS) are more related to technical aspects as bile leaks, or HAT, whereas NAS are related to risk factors including immunologic, IRI, or consequences of infectious complications ( 45 ). ITBL ( 46 ) is one of the major post-operative complications accounting for up to 38% of morbidity and mortality rates of all biliary complications.…”

Section: Discussionmentioning

confidence: 99%

The Graz Liver Allocation Strategy—Impact of Extended Criteria Grafts on Outcome Considering Immunological Aspects

et al. 2020

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Background: Transplant centers are forced to use livers of extended criteria donors for transplantation due to a dramatic organ shortage. The outcome effect of extended donor criteria (EDCs) remains unclear. Thus, this study was designed to assess the impact of EDCs on outcome including immunological aspects after liver transplantation (LT). Patients and Methods: Between November 2016 and March 2018, 49 patients (85.7% male) with a mean age of 57 ± 11 years underwent LT. The impact of EDCs on outcome after LT was assessed retrospectively using both MedOcs and ENIS (Eurotransplant Network Information System). Results: About 80% of grafts derived from extended criteria donors. Alanine aminotransferase/aspartate aminotransferase (AST/ALT) levels elevated more than three times above normal values in organ donors was the only significant risk factor for primary dysfunction (PDF) and primary non-function (PNF)/Re-LT and early non-anastomotic biliary strictures (NAS). Balance of risk (BAR) score did not differ between EDC and non-EDC recipients. PDF (14.3% of all patients) and PNF (6.1% of all patients) occurred in 23.1% of EDC-graft recipients and in 10.0% of non-EDC-graft recipients (RR 2.31, p = 0.663). The 90-day mortality was 3.6%. There was no difference of early non-anastomotic biliary tract complications and biopsy proven rejections (BPR). There was no correlation of PDF/PNF with BPR and NAS, respectively; however, 66.7% of the patients with BPR also developed early NAS ( p < 0.001). Conclusion: With the Graz liver allocation strategy, excellent survival can be achieved selecting livers with no more than 2 not outcome-relevant EDCs for patients with MELD >20. Further, BPR is associated with biliary complications.

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Bile duct strictures after liver transplantation

Abstract: The ongoing research in the aetiology, prevention, and treatment of biliary strictures after liver transplantation highlights the significance of biliary complications for patient and graft outcome.

Cited by 17 publications

References 35 publications

EUROCRINE®: Nebennierenoperationen 2015 bis 2019 – überraschende erste Ergebnisse

EUROCRINE®: Nebennierenoperationen 2015 bis 2019 – überraschende erste Ergebnisse

Biliary strictures complicating living donor liver transplantation: Problems, novel insights and solutions

The Graz Liver Allocation Strategy—Impact of Extended Criteria Grafts on Outcome Considering Immunological Aspects

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