Published on Apr 1, 2017
· DOI :10.1590/0102-6720201700020011
Júlio Cezar Uili Coelho1
Estimated H-index: 1
(UFPR: Federal University of Paraná),
Lucas de Oliveira Leite1
Estimated H-index: 1
(UFPR: Federal University of Paraná)
+ 2 AuthorsJorge Eduardo Fouto Matias13
Estimated H-index: 13
(UFPR: Federal University of Paraná)
BACKGROUND: Biliary reconstitution has been considered the Achilles's heel of liver transplantations due to its high rate of postoperative complications. AIM: To evaluate the risk factors for occurrence of biliary strictures and leakages, and the most efficient methods for their treatment. METHOD: Of 310 patients who underwent liver transplantation between 2001 and 2015, 182 medical records were retrospectively analyzed. Evaluated factors included demographic profile, type of transplantation and biliary reconstitution, presence of vascular and biliary complications, their treatment and results. RESULTS: 153 (84.07%) deceased donor and 29 (15.93%) living donor transplantations were performed. Biliary complications occurred in 49 patients (26.92%): 28 strictures (15.38%), 14 leakages (7.7%) and seven leakages followed by strictures (3.85%). Hepatic artery thrombosis was present in 10 patients with biliary complications (20.4%; p=0,003). Percutaneous and endoscopic interventional procedures (including balloon dilation and stent insertion) were the treatment of choice for biliary complications. In case of radiological or endoscopic treatment failure, surgical intervention was performed (biliodigestive derivation or retransplantation (32.65%). Complications occurred in 25% of patients treated with endoscopic or percutaneous procedures and in 42.86% of patients reoperated. Success was achieved in 45% of patients who underwent endoscopic or percutaneous procedures and in 61.9% of those who underwent surgery. CONCLUSION: Biliary complications are frequent events after liver transplantation. They often require new interventions: endoscopic and percutaneous procedures at first and surgical treatment when needed. Hepatic artery thrombosis increases the number of biliary complications.
#1Kadaba Rs (Barts Health NHS Trust)H-Index: 1
#1Raghu Kadaba (QMUL: Queen Mary University of London)H-Index: 3
Last. Hemant M. Kocher (QMUL: Queen Mary University of London)H-Index: 41
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INTRODUCTION Biliary-enteric anastomoses are performed for a range of indications and may result in early and late complications. The aim of this study was to assess the risk factors and management of anastomotic leak and stricture following biliary-enteric anastomosis. METHODS A retrospective analysis of the medical records of patients who underwent biliary-enteric anastomoses in a tertiary referral centre between 2000 and 2010 was performed. RESULTS Four hundred and sixty-two biliary-enteric a...
26 CitationsSource
#2Alberto Queiroz Farias (USP: University of São Paulo)H-Index: 20
Last. Cláudia Alves Couto (UFMG: Universidade Federal de Minas Gerais)H-Index: 16
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Over 1700 liver transplantations (LTs) are performed annually in Brazil. In absolute terms, the country performs more LT surgeries than anywhere else in Latin America and is third worldwide. However, due to its increasing population and inadequate donor organ supply, the country averages 5-10 LTs per million population, far lower than required. There is a marked heterogeneity in organ donation and LT activity throughout the country. Access to LT in the underprivileged North, Midwest, and Northea...
17 CitationsSource
#1Marcos Vinícius Zanchet (UFPR: Federal University of Paraná)H-Index: 3
#2Larissa Luvison Gomes da Silva (UFPR: Federal University of Paraná)H-Index: 4
Last. Júlio Cezar Uili Coelho (UFPR: Federal University of Paraná)H-Index: 23
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Background: The outcome of the patients after liver transplant is complex and to characterize the risk for complications is not always easy. In this context, the hepatic post-reperfusion biopsy is capable of portraying alterations of prognostic importance. Aim: To compare the results of liver transplantation, correlating the different histologic features of the hepatic post-reperfusion biopsy with graft dysfunction, primary non-function and patient survival in the first year after transplantatio...
6 CitationsSource
#1Lucas Souto NacifH-Index: 9
#2Liliana DucattiH-Index: 8
Last. Wellington AndrausH-Index: 16
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Introduction: Hepatic artery thrombosis (HAT) is a feared complication in the postoperative period of liver transplantation (LT). It is one of the most serious vascular complications in the postoperative period and associated with a significant increasing in morbidity, graft loss and mortality. Methods: Non-Systematic literature review through Medline-PubMed database with headings related to hepatic artery thrombosis and liver transplantation in articles published until November 2012 was done. D...
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Background: The liver is the most injured organ in abdominal trauma. Currently, the treatment in most cases is non-operative, but surgery may be necessary in severe abdominal trauma with blunt liver damage, especially those that cause uncontrollable bleeding. Despite the damage control approaches in order to achieve hemodynamic stability, many patients develop hypovolemic shock, acute liver failure, multiple organ failure and death. In this context, liver transplantation appears as the lifesavin...
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#1Balázs Nemes (University of Debrecen)H-Index: 13
#2György Gámán (Semmelweis University)H-Index: 8
Last. Attila Doros (Semmelweis University)H-Index: 13
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Biliary complications (BCs) remain one of the most outstanding factors influencing long-term results after orthotopic liver transplantation. The authors carried out a systematic overview of 1720 papers since 2008, and focused on 45 relevant ones. Among 14,411 transplanted patients the incidence of BCs was 23%. Biliary leakage occurred in 8.5%, biliary stricture in 14.7%, mortality rate was 1–3%. Risk factors: preoperative sodium level; p = 0.037, model of end-stage liver disease score >25; p = 0...
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In 1958 Francis Moore described the orthotopic liver transplantation technique in dogs. In 1963, Starzl et al. performed the first liver transplantation. In the first five liver transplantations no patient survived more than 23 days. In 1967, stimulated by Calne who used antilymphocytic serum, Starzl began a successful series of liver transplantation. Until 1977, 200 liver transplantations were performed in the world. In that period, technical problems were overcome. Roy Calne, in 1979, used the...
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#1David A. Axelrod (Dartmouth–Hitchcock Medical Center)H-Index: 46
#2Nino DzebisashviliH-Index: 14
Last. Dorry L. SegevH-Index: 95
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Although biliary complications (BCs) have a significant impact on the outcome of liver transplantation (LT), variation in BC rates among transplant centers has not been previously analyzed. BC rate, LT outcome and spending were assessed using linked Scientific Registry of Transplant Recipients and Medicare claims (n = 16,286 LTs). Transplant centers were assigned to BC quartiles based upon risk-adjusted observed to expected (O:E) ratio of BC separately for donation after brain death (DBD) and do...
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#1Umberto Maggi (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico)H-Index: 15
#2Enzo AndornoH-Index: 18
Last. Mario Scalamogna (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico)H-Index: 28
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This study is the largest Italian survey on liver retransplantations (RET). Data report on 167 adult patients who received 2 grafts, 16 who received 3 grafts, and one who received 4 grafts over a 11 yr period. There was no statistically significant difference in graft survival after the first or the second RET (52, 40, and 29% vs 44, 36, and 18% at 1,5,and 10 yr, respectively: Log-Rank test, p = 0.30). Survivals at 1, 5, and 10 years of patients who underwent 2 (n = 151) or 3 (n = 15) RETs, were...
14 CitationsSource
#1Scott W. Biggins (University of Colorado Denver)H-Index: 30
Donor livers are a scarce, life-saving resource. For patients whose lives depend upon liver transplantation, the policies defining priority for donor livers are of ultimate importance. Fair and just utilization of available livers requires that policy makers understand how to balance the needs and interests of each of the stakeholders. Although significant medical and surgical advances have been made in the last three decades, many patients who undergo liver transplantation will eventually have ...
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Cited By5
#1Jeremy J. Velazquez (University of Pittsburgh)
#1Jeremy J. Velazquez (University of Pittsburgh)H-Index: 8
Last. Mo R. EbrahimkhaniH-Index: 4
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Preoccupied with the astounding regenerative capabilities and metabolic importance of hepatocytes in the liver, the role of the resident "plumbers" of the liver, the cholangiocytes, can be overlooked in comparison. Cholangiocytes form the ductal network which makes up the biliary tree and transports bile from the liver to the gallbladder for secretion into the intestine during digestion. Chronic accumulation of bile in the liver is cytotoxic, causing fibrosis and eventually leads to cirrhosis an...
#1Iyad Faden (KSU: King Saud University)
#2Yaron Avitzur (U of T: University of Toronto)H-Index: 28
Last. Dimitri A. Parra (U of T: University of Toronto)H-Index: 12
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This case report describes a four-year-old boy who presented with the diagnosis of LCH with liver involvement. This required a living-related liver transplant one year later. The primary disease recurred in the transplanted liver 6 months post-transplant and led to progressive biliary dilatation. A percutaneous trans-hepatic cholangiogram was performed five years after transplant, showing a pattern of multifocal biliary duct strictures mimicking the pattern of primary sclerosing cholangitis and ...
#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
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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 ...
#1Neide da Silva Knihs (UFSC: Universidade Federal de Santa Catarina)H-Index: 4
#2Fernanda Lunardi (UFSC: Universidade Federal de Santa Catarina)H-Index: 1
Last. Bartira de Aguiar Roza (UNIFESP: Federal University of São Paulo)H-Index: 10
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Abstract Objective The objective of this study is to analyze the liver transplant complications in a reference transplant hospital in southern Brazil. Methods The researchers used a cross-sectional, quantitative, exploratory, and descriptive study, conducted using 103 medical records of patients who underwent liver transplantation from 2011 to 2018. Data were analyzed through median, mean, and standard deviation, and the Kruskal-Wallis test was used. Results There was a higher proportion of men ...
#1Yingzi MingH-Index: 2
#1Yingzi MingH-Index: 2
Last. Min YangH-Index: 1
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