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Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression.
- Source :
-
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2007 May; Vol. 13 (5), pp. 725-32. - Publication Year :
- 2007
-
Abstract
- Nonanastomotic biliary strictures (NAS) after orthotopic liver transplantation (OLT) are associated with high retransplant rates. The aim of the present study was to describe the treatment of and identify risk factors for radiological progression of bile duct abnormalities, recurrent cholangitis, biliary cirrhosis, and retransplantation in patients with NAS. We retrospectively studied 81 cases of NAS. Strictures were classified according to severity and location. Management of strictures was recorded. Possible prognostic factors for bacterial cholangitis, radiological progression of strictures, development of severe fibrosis/cirrhosis, graft survival, and patient survival were evaluated. Median follow-up after OLT was 7.9 years. NAS were most prevalent in the extrahepatic bile duct. Twenty-eight patients (35%) underwent some kind of interventional treatment, leading to a marked improvement in biochemistry. Progression of disease was noted in 68% of cases with radiological follow-up. Radiological progression was more prevalent in patients with early NAS and one or more episodes of bacterial cholangitis. Recurrent bacterial cholangitis (>3 episodes) was more prevalent in patients with a hepaticojejunostomy. Severe fibrosis or cirrhosis developed in 23 cases, especially in cases with biliary abnormalities in the periphery of the liver. Graft survival, but not patient survival, was influenced by the presence of NAS. Thirteen patients (16%) were retransplanted for NAS. In conclusion, especially patients with a hepaticojejunostomy, those with an early diagnosis of NAS, and those with NAS presenting at the level of the peripheral branches of the biliary tree, are at risk for progressive disease with severe outcome.
- Subjects :
- Adult
Aged
Bacterial Infections
Bile Duct Diseases diagnostic imaging
Bile Duct Diseases pathology
Cholangiography
Cholangitis epidemiology
Cholangitis etiology
Cholangitis microbiology
Constriction, Pathologic
Disease Progression
Female
Graft Survival
Humans
Incidence
Liver pathology
Liver Cirrhosis etiology
Male
Middle Aged
Postoperative Complications
Predictive Value of Tests
Retrospective Studies
Risk Factors
Survival Analysis
Treatment Outcome
Bile Duct Diseases therapy
Liver Transplantation
Postoperative Care
Subjects
Details
- Language :
- English
- ISSN :
- 1527-6465
- Volume :
- 13
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
- Publication Type :
- Academic Journal
- Accession number :
- 17457935
- Full Text :
- https://doi.org/10.1002/lt.21165