Biliary tract complications and its prevention

Lerut, Jan

doi:10.1002/lt.24311

Cited by 5 publications

(1 citation statement)

References 25 publications

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“…Biliary tract complications (BTCs) are a major source of morbidity and an underrated cause of delayed graft and patient loss after liver transplantation (LT). The reported incidence, in retrospective studies, varies from 10–40% [1–7]. The first report published in 1984 by the Pittsburgh team revealed BTC in 13% of patients [8].…”

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confidence: 99%

The real incidence of biliary tract complications after adult liver transplantation: the role of the prospective routine use of cholangiography during post‐transplant follow‐up

et al. 2020

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Summary Biliary tract complications (BTCs) still burden liver transplantation (LT). The wide reporting variability highlights the absence of systematic screening. From 2000 to 2009, simultaneous liver biopsy and direct biliary visualization were prospectively performed in 242 recipients at 3 and 6 months (n = 212, 87.6%) or earlier when indicated (n = 30, 12.4%). Median follow‐up was 148 (107–182) months. Seven patients (2.9%) experienced postprocedural morbidity. BTCs were initially diagnosed in 76 (31.4%) patients; 32 (42.1%) had neither clinical nor biological abnormalities. Acute cellular rejection (ACR) was present in 27 (11.2%) patients and in 6 (22.2%) BTC patients. Nine (3.7%) patients with normal initial cholangiography developed BTCs after 60 (30–135) months post‐LT. BTCs directly lead to 7 (2.9%) re‐transplantations and 14 (5.8%) deaths resulting in 18 (7.4%) allograft losses. Bile duct proliferation at 12‐month biopsy proved an independent risk factor for graft loss (P = 0.005). Systematic biliary tract and allograft evaluation allows the incidence and extent of biliary lesions to be documented more precisely and to avoid erroneous treatment of ACR. The combination ‘abnormal biliary tract‐canalicular proliferation’ is an indicator of worse graft outcome. BTCs are responsible for important delayed allograft and patient losses. These results underline the importance of life‐long follow‐up and appropriate timing for re‐transplantation.

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Section: Introductionmentioning

confidence: 99%

The real incidence of biliary tract complications after adult liver transplantation: the role of the prospective routine use of cholangiography during post‐transplant follow‐up

et al. 2020

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Long‐term Management of the Liver Transplant Patient

McCashland

2017

Schiff's Diseases of the Liver

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Biliary Complications After Liver Transplantation From Uncontrolled Donors After Circulatory Death: Incidence, Management, and Outcome

et al. 2019

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The utilization of livers from donation after uncontrolled circulatory death (uDCD) increases the availability of liver grafts, but it is associated with a higher incidence of biliary complications (BCs) and lower graft survival than those organs donated after brain death. From January 2006 to December 2016, we performed 75 orthotopic liver transplantations (OLTs) using uDCD livers. To investigate the relationship of BCs with the use of uDCD OLT, we compared patients who developed BCs (23 patients) with those who did not (non‐BC group, 43 patients) after excluding cases of hepatic artery thrombosis (a known cause of BC) and primary nonfunction. The groups had similar uDCD donor maintenance, donor and recipient characteristics, and perioperative morbidity/mortality rates, but we observed a higher rate of hepatocellular carcinoma and hepatitis C virus in the non‐BC group. Percutaneous transhepatic biliary dilation, endoscopic retrograde cholangiopancreatography dilation, Roux‐en‐Y hepaticojejunostomy (HJ), a T‐tube, and retransplantation were used for BC management. In the BC group, 1‐, 3‐, and 5‐year patient survival rates were 91.3%, 69.6%, and 65.2%, respectively, versus 77.8%, 72.9%, and 72.9%, respectively, in the non‐BC group (P = 0.89). However, 1‐, 3‐, and 5‐year graft survival rates were 78.3%, 60.9%, and 56.5%, respectively, in the BC group versus 77.8%, 72.9%, and 72.9%, respectively, in the non‐BC group (P = 0.38). Multivariate analysis did not indicate independent risk factors for BC development. In conclusion, patient and graft survival rates were generally lower in patients who developed BCs but not significantly so. These complications were managed in the majority of patients through radiological dilation, endoscopic dilation, or Roux‐en‐Y HJ. Retransplantation is necessary in rare cases after the failure of biliary dilation or surgical procedures.

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Biliary tract complications and its prevention

Cited by 5 publications

References 25 publications

The real incidence of biliary tract complications after adult liver transplantation: the role of the prospective routine use of cholangiography during post‐transplant follow‐up

The real incidence of biliary tract complications after adult liver transplantation: the role of the prospective routine use of cholangiography during post‐transplant follow‐up

Long‐term Management of the Liver Transplant Patient

Biliary Complications After Liver Transplantation From Uncontrolled Donors After Circulatory Death: Incidence, Management, and Outcome

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