Current management of biliary complications after liver transplantation: Emphasis on endoscopic therapy

Balderramo, Domingo; Navasa, Miguel; Cárdenas, Andrés

doi:10.1016/j.gastrohep.2010.05.008

Cited by 59 publications

(41 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A predictive cut-off of 6.75 mo for the duration of stent therapy was found to have reasonable validity for eventual favourable response to endotherapy. Most studies in this area have found an average stent duration between 6 mo to 1 year with 3-4 endotherapy sessions to be adequate in preventing recurrences with minimal complications and morbidity[7,40,41]. …”

Section: Discussionmentioning

confidence: 99%

Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome

Rao

Ahamed

Panicker

et al. 2017

WJGP

View full text Add to dashboard Cite

AIMTo identify factors predicting outcome of endoscopic therapy in bile duct strictures (BDS) post living donor liver transplantation (LDLT).METHODSPatients referred with BDS post LDLT, were retrospectively studied. Patient demographics, symptoms (Pruritus, Jaundice, cholangitis), intra-op variables (cold ischemia time, blood transfusions, number of ducts used, etc.), peri-op complications [hepatic artery thrombosis (HAT), bile leak, infections], stricture morphology (length, donor and recipient duct diameters) and relevant laboratory data both pre- and post-endotherapy were studied. Favourable response to endotherapy was defined as symptomatic relief with > 80% reduction in total bilirubin/serum gamma glutamyl transferase. Statistical analysis was performed using SPSS 20.0.RESULTSForty-one patients were included (age: 8-63 years). All had right lobe LDLT with duct-to-duct anastomosis. Twenty patients (48.7%) had favourable response to endotherapy. Patients with single duct anastomosis, aggressive stent therapy (multiple endoscopic retrograde cholagiography, upsizing of stents, dilatation and longer duration of stents) and an initial favourable response to endotherapy were independent predictors of good outcome (P < 0.05). Older donor age, HAT, multiple ductal anastomosis and persistent bile leak (> 4 wk post LT) were found to be significant predictors of poor response on multivariate analysis (P < 0.05).CONCLUSIONEndoscopic therapy with aggressive stent therapy especially in patients with single duct-to-duct anastomosis was associated with a better outcome. Multiple ductal anastomosis, older donor age, shorter duration of stent therapy, early bile leak and HAT were predictors of poor outcome with endotherapy in these patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome

Rao

Ahamed

Panicker

et al. 2017

WJGP

View full text Add to dashboard Cite

show abstract

“…Up to 50% of patients with nonanastomotic BS, and in particular diffuse intrahepatic BS, are not amenable to endoscopic or surgical treatments. 375 EAD and BS are the end result of a cascade of tissue injuries that precede transplantation (preexisting disease in the donor, brain death-induced injury, surgical trauma, cold preservation and warm ischemia), and culminate in IRI in the recipient. 376 The incidence of EAD in liver transplant recipients ranges from 21% to 25% 377 ; the incidence of nonanastomotic BS is 0.5% to 10% and these account for 10% to 25% of all strictures complicating liver transplant.…”

Section: Prevention Of Early Ischemic Injury and Dgf In Kidney Transpmentioning

confidence: 99%

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

et al. 2017

View full text Add to dashboard Cite

Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes. COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant. The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting. 12 Department of Gastroenterology and Hepatology, Erasmus MC, University Hospital Rotterdam, the Netherlands. 13 Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Belgium.14 Abdominal Transplant Surgery, Microbiology and Immunology Department, University Hospitals KU Leuven, Belgium. 15 Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Spain. www.transplantjournal.com S1 S olid organ transplantation has evolved from an experimental procedure to an established treatment option for many types of end-stage organ failure. Both patient and graft outcomes are continuing to improve, and 1-year patient and graft survival currently exceed 80%.1,2 However, survival rates gradually decline over the long term. In kidney transplant, 5-and 10-year graft survival rates in Europe are 77% and 56%, and for liver transplant, 64% and 54% (Figures 1 and 2). 3,4 Although most European countries have seen an increase in both living and deceased donation, transplantation is not available to all who would benefit from the procedure, and there is considerable morbidity and mortality for those listed for transplant.6 Therefore, maximizing long-term graft survival and reducing the need for retransplantation is paramount, not only in improving outcomes for the recipients but also for those awaiting a graft. The improvement in outcomes is predominantly due to reduction in (Transplantation. 2017;101:S1-S41). The authors were approached by Astellas to discuss the practical implementation o...

show abstract

“…122 The incidence of BS in livers from deceased and living donors varies widely, from 4% to 40%. 124 Risk factors include donation after cardiac death, donor age, prolonged warm and cold ischemia time, and extended use of vasopressors in the donor. 125 There are a variety of interventions that can be considered in the prevention of EAD and BS.…”

Section: Early Allograft Dysfunction and Biliary Strictures After LIVmentioning

confidence: 99%

Advancing Transplantation

et al. 2017

View full text Add to dashboard Cite

Current management of biliary complications after liver transplantation: Emphasis on endoscopic therapy

Cited by 59 publications

References 52 publications

Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome

Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

Advancing Transplantation

Contact Info

Product

Resources

About