Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy

Rerknimitr, Rungsun; Sherman, Stuart; Fogel, Evan L.; Kalaycı, Cem; Lumeng, Lawrence; Chalasani, Naga; Kwo, Paul Y.; Lehman, Glen A.

doi:10.1067/mge.2002.120813

Cited by 272 publications

(228 citation statements)

References 25 publications

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“…Biliary complications occur in 25-30% of patients transplanted for all types of liver disease. 38,39 In this study, biliary tract complications occurred in 45% of the patients, including four cases that were closely associated with recurrent EPP liver disease. Thus biliary tract complications need to be identified and corrected early before protoporphyrin deposits accumulate and cause damage to the bile ducts and the hepatocytes.…”

Section: Discussionmentioning

confidence: 62%

Liver transplantation for erythropoietic protoporphyria liver disease

et al. 2005

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In erythropoietic protoporphyria (EPP), there is excessive production of protoporphyrin, primarily in the bone marrow, resulting in increased biliary excretion of this heme precursor. Some patients will develop progressive liver disease that may ultimately require liver transplantation. However, excessive production of protoporphyrin by the bone marrow continues after transplantation, which may cause recurrent disease in the allograft. This study was performed to define post-transplant survival, the risk of recurrent disease, and specific management issues in patients transplanted for EPP liver disease. The patients studied consisted of twelve males and eight females, with an average age of 31 (range, 13-56) years at the time of transplantation. The estimated maximum MELD score prior to transplant was 21 (range, 15-29). Unique complications in the perioperative period were light induced tissue damage in four patients and neuropathy in six, requiring prolonged mechanical ventilation in four. Patient and graft survival rates were 85% at 1 year, 69% at 5 years, and 47% at 10 years. Recurrent EPP liver disease occurred in 11 of 17 patients (65%) who survived more than 2 months. Three patients were retransplanted at 1.8, 12.6, and 14.5 years after the initial transplant for recurrent EPP liver disease. In conclusion, the 5-year patient survival rate in patients transplanted for EPP liver disease is good, but the recurrence of EPP liver disease appears to diminish long term graft and patient survival. (Liver Transpl 2005;11:1590-1596.)

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Section: Discussionmentioning

confidence: 62%

Liver transplantation for erythropoietic protoporphyria liver disease

et al. 2005

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“…Moreover, the chief disadvantage of MRC in general, beyond lack of availability, is the lack of its therapeutic ability (Williams & Draganov, 2009). Currently, cumulative results confirm that none of the indirect imaging modalities could replace direct cholangiography for diagnosis of post transplantation biliary strictures (Pascher & Neuhaus, 2006;Pfau et al, 2000;Rerknimitr et al, 2002;Thuluvath et al, 2005;Zoepf et al, 2005).…”

Section: Value Of Radiological Modalities In Diagnosis Of Biliary Strmentioning

confidence: 99%

“…The majority of patients with anastomotic strictures will require several endoscopic interventions every 3 months with a mean of 3 to 5 sessions, using balloon dilation of 6-10 mm and multiple stents of 7 Fr to 10 Fr repeated for 12-24 months (Morelli et al, 2003;Thuluvath et al, 2005). The long-term success rates were in the range of 70%-100% (Alazmi et al, 2006;Morelli et al, 2003;Rerknimitr et al, 2002;Verdonk et al, 2006). A small group of patients, with transient anastomotic narrowing during the first 1-2 month post transplant, presumably due to postoperative edema, may respond with a single session of endoscopic balloon dilatation and plastic stent placement with no need for further intervention ).…”

Section: Deceased Donor Liver Transplantation (Ddlt)mentioning

confidence: 99%

“…Compared to AS, non-anastomotic strictures are more difficult to treat with more complications and less favorable overall outcomes including increased graft loss and death (Williams & Draganov, 2009). It is reported that only 50%-75% of DDLT patients had a long term response to endoscopic therapy and the median time of response was 185 days; on the other hand, long term response in patients with anastomotic strictures was 70%-100% and the median time of response was 67 days (Graziadei et al, 2006;Pfau et al, 2000;Rerknimitr et al, 2002;Thuluvath et al, 2005). The results of endoscopic approaches in the context of NAS in LDLT are even more disappointing, as the average success rate varies from 25% to 33% (Todo et al, 2005;Tsujino et al, 2006;, which is way below the success rate seen with NAS in DDLT.…”

Section: Management Of Nasmentioning

confidence: 99%

“…For instance, Riknimitir et al reported the occurrence of biliary stones in 38% of their patients (Rerknimitr et al, 2002), while others reported an incidence of 4-18% of post liver transplant patients (de la Mora-Levy & Baron, 2005).The exact etiology is unclear, however, this could be explained theoretically by increased lithogenicity of the bile or as a result of cyclosporine inhibitory effect on bile acid production and bile flow. However, post transplant calculi formation is most likely the result of mechanical obstruction mainly strictures (de la Mora-Levy & Baron, 2005;Thuluvath et al, 2005), biliary tract infection, biliary reflux and biliary mucosal inflammation.…”

Section: Biliary Stonesmentioning

confidence: 99%

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