Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer, Daniel; Eurich, Dennis; Veltzke‐Schlieker, Wilfried; Neuhaus, P.

doi:10.1111/ajt.12034

Cited by 258 publications

(261 citation statements)

References 108 publications

(170 reference statements)

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“…In the present study, there was no significant difference in biliary leak rates in the wound area when we compared Groups A and B. Biliary leak in liver transplantation is directly related to complications in the hepatic artery and an important cause of morbidity, with rates in the literature ranging from 5 to 10% in whole-liver transplantation [26][27][28] . In cases of liver transplantation with the split technique, these rates may increase 28,29 , reaching about 18.8%, as described by Diamond et al 30 .…”

Section: ■ Discussioncontrasting

confidence: 51%

Use of fibrinogen and thrombin sponge in pediatric split liver transplantation

et al. 2017

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Purpose: To analyze the use of this sponge in pediatric patients undergoing split-liver transplantation. Methods: Retrospective study, including 35 pediatric patients undergoing split-liver transplantation, divided into two groups according to the use of the sponge: 18 patients in Group A (no sponge) and 17 in Group B (with sponge). Results: The characteristics of recipients and donors were similar. We observed greater number of reoperation due to bleeding in the wound area in Group A (10 patients -55.5%) than in Group B (3 patients -17.6%); p = 0.035. The median volume of red blood cells transfused in Group A was significantly higher (73.4 ± 102.38 mL/kg) than that in Group B (35.1 ± 41.67 mL/kg); p = 0.048. Regarding bile leak there was no statistical difference. Conclusion: The use of the human fibrinogen and thrombin sponge, required lower volume of red blood cell transfusion and presented lower reoperation rates due to bleeding in the wound area.

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Section: ■ Discussioncontrasting

confidence: 51%

Use of fibrinogen and thrombin sponge in pediatric split liver transplantation

et al. 2017

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“…Vascular anatomy of the donor, localization of bile ducts relative to the portal vein, and the number and diameter of bile canals are important risk factors for biliary complications developing after transplant. 12 However, it is very difficult to verify the real effects of technical factors in biliary complications of LDLT because there are many perturbed variables in the surgical field. In addition, the preservation of blood supply to anastomosis is also important to prevent late biliary stricture.…”

Section: Discussionmentioning

confidence: 99%

“…Although biliary anatomic variations in donors and surgical techniques are widely acknowledged risk factors for recipient biliary complications, 9,10 it has been reported that donor age, donor body mass index, and macrovacuolar steatosis of the graft may be independent risk factors for biliary complications. 11,12 The relation between bile ducts and portal vein confluence may be an independent risk factor for bile duct complications.…”

Section: Introductionmentioning

confidence: 99%

Effect of Right Posterior Bile Duct Anatomy on Biliary Complications in Patients Undergoing Right Lobe Living Donor Liver Transplant

Tezcaner¹,

Dinc²,

Karakayalı³

et al. 2019

Exp Clin Transplant

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Objectives: Our aim was to evaluate the influence of the localization of right posterior bile duct anatomy relative to portal vein of the donors on posttransplant bile duct complications. Materials and Methods: We retrospectively investigated 141 patients who had undergone living donor liver transplant using right hemiliver grafts. The patients were classified based on the pattern of the right posterior bile duct and divided into infraportal and supraportal types. Clinical donor and recipient risk factors and surgical outcomes were compared for their relationship with biliary complications using logistic regression analyses. Results: The 2 groups were similar according to demographic and clinical features. The biliary complication rate was 23.7% (9/38) in the infraportal group and 47.4% (37/78) in the supraportal group (P = .014). An analysis of risk factors for the development of anastomotic bile leak using logistic regression showed that a supraportal right posterior bile duct anatomy was a statistically significant positive predictor, with odds ratio of 18.905 (P = .012; confidence interval, 1.922-185.967). The distance of the right posterior bile duct from confluence was significantly lower in patients with biliary complications than in those without (mean of 7.66 vs 0.40 mm; P = .044). According to receiver operating characteristic analyses, the cutoff point for the length of right bile duct to right posterior bile duct from the hepatic confluence was 9.5 mm regarding presence of complications. Conclusions: Factors influencing bile duct anastomosis leakage were supraportal-type donor bile duct anatomy and length of the right main bile duct from biliary confluence. Hepatic arterial complications were similarly a risk factor for biliary strictures. Because of the multiple factors leading to complications in living donor liver transplant, it is challenging to group these patients by operative risk; however, establishing risk models may facilitate the prediction of complications.

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“…When compared with the current standard for liver preservation (static cold storage), ex vivo machine perfusion provides numerous potential benefits, all of which result in much-needed expansion of the organ pool and a potentially decrease in the incidence of post-transplant complications. In particular, the biliary complications that currently plague suboptimal-quality liver grafts after transplantation remain a substantial issue [14][15][16][17][18] . Machine perfusion at subnormothermic conditions provides a time window to assess graft function objectively as to suitability for transplantation 19 .…”

Section: Introductionmentioning

confidence: 99%

Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion

Bruinsma

Avruch

Weeder

et al. 2015

JoVE

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There is currently a severe shortage of liver grafts available for transplantation. Novel organ preservation techniques are needed to expand the pool of donor livers. Machine perfusion of donor liver grafts is an alternative to traditional cold storage of livers and holds much promise as a modality to expand the donor organ pool. We have recently described the potential benefit of subnormothermic machine perfusion of human livers. Machine perfused livers showed improving function and restoration of tissue ATP levels. Additionally, machine perfusion of liver grafts at subnormothermic temperatures allows for objective assessment of the functionality and suitability of a liver for transplantation. In these ways a great many livers that were previously discarded due to their suboptimal quality can be rescued via the restorative effects of machine perfusion and utilized for transplantation. Here we describe this technique of subnormothermic machine perfusion in detail. Human liver grafts allocated for research are perfused via the hepatic artery and portal vein with an acellular oxygenated perfusate at 21 °C.

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Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Cited by 258 publications

References 108 publications

Use of fibrinogen and thrombin sponge in pediatric split liver transplantation

Use of fibrinogen and thrombin sponge in pediatric split liver transplantation

Effect of Right Posterior Bile Duct Anatomy on Biliary Complications in Patients Undergoing Right Lobe Living Donor Liver Transplant

Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion

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