Biliary Complications After Liver Transplantation: Incidence, Risk Factors and Impact on Patient and Graft Survival.

Published on Mar 1, 2016
· DOI :10.1016/J.TRANSPROCEED.2016.02.033
G.A. Mejía1
Estimated H-index: 1
,
C. Olarte-Parra1
Estimated H-index: 1
+ 2 AuthorsCarlos Benavides5
Estimated H-index: 5
Sources
Abstract
Abstract Introduction Biliary complications (BC) are one of the most frequent surgical complications after liver transplantation. They include biliary stenosis, leaks, choledocolitiasis and sphincter of Oddi dysfunction. These complications can cause graft dysfunction, retrasplantation, or even death. The purpose of this study was to identify factors related to BC. Materials and Methods The medical records of all adult patients who underwent their first liver transplantation in our institution from 2005 to 2013 were reviewed, and any BC that required management was recorded. Cumulative incidence of BC was estimated using Kaplan-Meier. Patient and graft survival was compared using the log-rank test. The Cox regression model was used to establish associated factors. Results Of the 236 patients who underwent liver transplantation, 41 patients (17.8%) developed BC. Cumulative incidence was 12.9%, 17.2%, and 20%, after 1, 3 and 5 years of the transplantation, respectively. Twenty-six cases of biliary stenosis, 11 of leaks, and 4 of choledocolitiasis were identified. Most patients were managed endoscopically (82.9%). There were no differences in patient or graft survival. Discussion Biliary stenosis is the most frequent BC. Patients with higher risk of BC were of blood type AB ( P P  = .049), or had alcoholic cirrhosis ( P  = .036). The success with the endoscopic treatment reduced the need for surgical interventions. Conclusions The incidence of BC in our institution is comparable with the incidence reported in other institutions. Further prospective studies with larger series of patients are warranted to identify other factors associated with development of BC.
References7
Newest
#1Amit K. Mathur (Mayo Clinic)H-Index: 27
#2Satish N. Nadig (MUSC: Medical University of South Carolina)H-Index: 8
Last. Theodore H. Welling (UM: University of Michigan)H-Index: 28
view all 7 authors...
Background Biliary complications are a leading source of surgical morbidity following orthotopic liver transplantation (OLT). Methods We examined how prophylactic internal biliary stent placement during OLT affected post-transplant morbidity and mortality in a single-center retrospective cohort study of 513 recipients (2006–2012). Recipient and donor covariates were collected. Biliary complications included major and minor anastomotic leaks, strictures, or stenoses. Multivariate regression model...
9 CitationsSource
BACKGROUND AND AIMS: The most common complications after liver transplantation nowadays affect the biliary tract.We carried out a retrospective study to identify predictors of endoscopic treatment outcome in the management of post-transplantation biliary complications. METHODS: Data from all patients with post-transplantation biliary complications subjected to endoscopic treatment at the University of Udine between 2000 and 2012 were extracted. To identify predictors of endoscopic treatment outc...
12 CitationsSource
#1György GámánH-Index: 8
#2Fanni GelleyH-Index: 9
Last. Balázs NemesH-Index: 13
view all 8 authors...
Biliary complications (BC) significantly affect morbidity and mortality after orthotopic liver transplantation (OLT). The aim of this study was to analyze the incidence and types of biliary complications after OLT in Hungary. We retrospectively analyzed data of 471 adult liver transplant recipients between 1995 and 2011. Biliary complications occurred in 28% of patients. The most frequent BCs were bile duct stricture, stenosis (19%), biliary leakage (12%), and necrosis (BN: 6.4%). Biliary compli...
12 CitationsSource
#1Vanesa GarcíaH-Index: 2
#2Federico Acosta (UdeA: University of Antioquia)H-Index: 2
Last. Pablo Tobón UribeH-Index: 1
view all 9 authors...
Background: Biliary complications after liver transplantation are a serious cause of morbidity and mortality. Direct invasive cholangiography techniques, endoscopic retrograde cholangiography (ERCP) and percutaneous transhepatic cholangiography (PTC) all have procedure-related complications. Ultrasonography and magnetic resonance cholangiopancreatography (MRCP) are non-invasive, safe, and accurate. Objective: The aim of this study was to evaluate the use of US and MRCP for detecting biliary comp...
1 Citations
#1Rodrigo Castaño Llano (UdeA: University of Antioquia)H-Index: 5
Last. Gonzalo Correa Arango (UdeA: University of Antioquia)H-Index: 3
view all 10 authors...
Background. Complications of bile duct reconstruction following liver transplantation are common and are an important cause of morbidity and mortality. Currently, endoscopic retrograde cholangio- pancreatography (ERCP) is an attractive alternative for management of biliary complications. It has high diagnostic and therapeutic utility, is less invasive than other techniques and has low morbidity. The aims of this study are to evaluate the results of endoscopic management of patients with biliary ...
2 Citations
#1Gilberto MejíaH-Index: 2
Last. Rafael Claudino BoteroH-Index: 3
view all 7 authors...
1 Jefe Servicio de Trasplantes, Departamento de Cirugia. Fundacion Cardio-Infantil, Bogota, Colombia. 2 Servicio de Gastroenterologia y Hepatologia, Departamento de Medicina Interna. Fundacion Cardio-Infantil, Bogota, Colombia. 3 Jefe Servicio de Gastroenterologia, Departamento de Medicina Interna. Fundacion Cardio-Infantil, Bogota, Colombia. 4 Jefe Servicio de Hepatologia, Departamento de Medicina Interna. Fundacion Cardio-Infantil, Bogota, Colombia.
2 Citations
#1Jan P. Vandenbroucke (LUMC: Leiden University Medical Center)H-Index: 113
#2E von Elm (University of Bern)H-Index: 2
Last. Matthias Egger (University of Bern)H-Index: 168
view all 9 authors...
This Explanation and Elaboration paper supports the STROBE Statement in this issue. It is available online only.
2,165 CitationsSource
Cited By11
Newest
#1Agnaldo Soares Lima (UFMG: Universidade Federal de Minas Gerais)H-Index: 17
#2Bárbara Buitrago Pereira (Residence Inn by Marriott)
Last. Maria Isabel Toulson Davison Correia (UFMG: Universidade Federal de Minas Gerais)
view all 5 authors...
BACKGROUND - Biliary complications (BC) represent the most frequent complication after liver transplantation, up to 34% of cases. AIM To identify modifiable risk factors to biliary complications after liver transplantation, essential to decrease morbidity. METHOD Clinical data, anatomical characteristics of recipient and donors, and transplant operation features of 306 transplants with full arterial patency were collected to identify risk factors associated with BC. RESULTS BC occurred in 22.9% ...
Source
#1R. Allard (St James's University Hospital)
#2Claire Smith (St James's University Hospital)
Last. Raneem Albazaz (St James's University Hospital)H-Index: 2
view all 6 authors...
Biliary complications post liver transplantation are a significant source of morbidity and mortality and early recognition is paramount to the long-term success of the liver graft. Part II of this series will focus on liver transplant biliary anatomy, including the blood supply to the biliary system and potential problems if it is interrupted. The imaging rationale for investigating suspected biliary complications, potential pitfalls, and treatment options will be discussed. The various biliary ...
Source
Real-world evidence (RWE) is emerging as a fundamental component of the post-marketing evaluation of medicinal products. Even though the focus on RWE studies has increased in Colombia, the availability of secondary data sources to perform this type of research is not well documented. Thus, we aimed at identifying and characterizing secondary data sources available in Colombia. We performed a systematic literature review on PubMed, EMBASE, and VHL using a combination of controlled vocabulary and ...
1 CitationsSource
#1Lin Chen (JLU: Jilin University)H-Index: 1
#2Xiaodong Shi (JLU: Jilin University)H-Index: 5
Last. Wanyu Li (JLU: Jilin University)H-Index: 7
view all 10 authors...
Background & Aims Factors that influence the outcomes after deceased-donor liver transplantation (DDLT) for primary biliary cirrhosis (PBC) are not well known. We aimed to clarify these effects on the outcomes after DDLT. Methods We retrospectively analyzed patients with PBC who underwent DDLT from March 2006 to July 2018 at the organ transplantation center of the First Hospital of Jilin University and the First Central Hospital of Tianjin. Changes in liver function were assessed posttransplanta...
1 CitationsSource
#1Faisal Naseer (Memorial Hospital of South Bend)H-Index: 1
#2Cen-Hung Lin (CGU: Chang Gung University)H-Index: 1
Last. Yuan-Cheng Chiang (CGU: Chang Gung University)H-Index: 4
view all 6 authors...
Abstract Background Bile duct complications hamper patient recovery from a transplant, curtail patient quality of life, and may impair the function and persistent survival of the allograft. The aim of this study is to compare the results of biliary reconstruction using 6-0 polypropylene and 6-0 polydioxanone. Methods A single-center retrospective study was performed on 133 patients who underwent microsurgical biliary reconstruction during living donor liver transplantation between November 2014 ...
2 CitationsSource
#1Fady M. Kaldas (UCLA: University of California, Los Angeles)H-Index: 29
#2Islam M. Korayem (Alexandria University)H-Index: 2
Last. Ronald W. Busuttil (UCLA: University of California, Los Angeles)H-Index: 130
view all 10 authors...
Importance Anastomotic biliary complications (ABCs) constitute the most common technical complications in liver transplant (LT). Given the ever-increasing acuity of LT, identification of factors contributing to ABCs is essential to minimize morbidity and optimize outcomes. A detailed analysis in a patient population undergoing high-acuity LT is lacking. Objective To evaluate the rate of, risk factors for, and outcomes of ABCs and acuity level in LT recipients. Design, Setting, and Participants T...
9 CitationsSource
#1Jesper Rönning (Karolinska University Hospital)H-Index: 1
#2Erik Berglund (Karolinska University Hospital)H-Index: 10
Last. Greg Nowak (Karolinska University Hospital)H-Index: 16
view all 5 authors...
Background: Biliary complications occur in 6% to 34% of liver transplant recipients, for which endoscopic retrograde cholangiopancreatography has become widely accepted as the first-line therapy. We evaluated long-term outcome of biliary complications in patients liver transplanted between 2004 and 2014 at Karolinska University Hospital, Stockholm. Methods: Data were retrospectively collected, radiological images were analyzed for type of biliary complication, and graft and patient survivals wer...
4 CitationsSource
#1Beverley KokH-Index: 6
#2Victor DongH-Index: 3
Last. Constantine J. KarvellasH-Index: 30
view all 3 authors...
: Graft dysfunction of the liver allograft manifests across a spectrum in both timing posttransplantation and clinical presentation. This can range from mild transient abnormalities of liver tests to acute liver failure potentially leading to graft failure. The causes of graft dysfunction can be divided into those resulting in early and late graft dysfunction. Although nonspecific, liver biochemistry abnormalities are still the mainstay investigation used in monitoring for dysfunction. This arti...
2 CitationsSource
#1Thomas R. Daugaard (Copenhagen University Hospital)H-Index: 1
#2Hans-Christian Pommergaard (Copenhagen University Hospital)H-Index: 22
Last. Allan Rasmussen (Copenhagen University Hospital)H-Index: 25
view all 4 authors...
Abstract Background Liver transplantation is major surgery with a high risk of complications. Existing scoring systems for evaluating complications after surgery are not specific for liver transplantation. Nor are they designed to evaluate the relation to recipient survival or graft loss. We wished to uncover the relation between postoperative complications and one-year risk of death or retransplantation, and to develop a prognostic score for complications based on our findings. Method The study...
5 CitationsSource
#1Regina Cheuk-Lam Lo (HKU: University of Hong Kong)H-Index: 20
#2Kristy Kwan-Shuen Chan (HKU: University of Hong Kong)H-Index: 4
Last. Irene Oi-Lin Ng (HKU: University of Hong Kong)H-Index: 110
view all 4 authors...
Aims Liver allograft biopsy is important in the management of liver transplant (LT) recipients. Cholestasis is an indicator of liver dysfunction, and histological evidence of cholestasis can be observed in a wide range of pathological entities in the post-LT setting. In this study, we describe the clinicopathological features and significance of liver allograft biopsies with histological cholestasis over 11 years in our centre. Methods Liver allograft biopsies performed in Queen Mary Hospital, H...
1 CitationsSource