A Review on the Management of Biliary Complications after Orthotopic Liver Transplantation

Moy, Brian; Birk, John

doi:10.14218/jcth.2018.00028

Cited by 68 publications

(88 citation statements)

References 113 publications

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“…With associated mortality of 10%, they remain a major problem in post-transplant patients. Timely identification and treatment play a significant role in preserving the graft and improving the overall survival rate of patients[ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Post-liver transplant biliary complications: Current knowledge and therapeutic advances

Boeva

Karagyozov

Tishkov

2021

WJH

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Liver transplantation is the current standard of care for end-stage liver disease and an accepted therapeutic option for acute liver failure and primary liver tumors. Despite the remarkable advances in the surgical techniques and immunosuppressive therapy, the postoperative morbidity and mortality still remain high and the leading causes are biliary complications, which affect up to one quarter of recipients. The most common biliary complications are anastomotic and non-anastomotic biliary strictures, leaks, bile duct stones, sludge and casts. Despite the absence of a recommended treatment algorithm many options are available, such as surgery, percutaneous techniques and interventional endoscopy. In the last few years, endoscopic techniques have widely replaced the more aggressive percutaneous and surgical approaches. Endoscopic retrograde cholangiography is the preferred technique when duct-to-duct anastomosis has been performed. Recently, new devices and techniques have been developed and this has led to a remarkable increase in the success rate of minimally invasive procedures. Understanding the mechanisms of biliary complications helps in their early recognition which is the prerequisite for successful treatment. Aggressive endoscopic therapy is essential for the reduction of morbidity and mortality in these cases. This article focuses on the common post-transplant biliary complications and the available interventional treatment modalities.

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Section: Introductionmentioning

confidence: 99%

Post-liver transplant biliary complications: Current knowledge and therapeutic advances

Boeva

Karagyozov

Tishkov

2021

WJH

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“…The incidence of non-anastomotic stricture is 0.5% to 10%, while stones/sludge are seen post-LT in approximately 5% of patients. Biliary cast syndrome is less common (2.5%-3%)[ 19 - 22 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography and liver biopsy in the evaluation of elevated liver function tests after liver transplantation

Attwell

Han

Kriss

2021

WJH

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BACKGROUND Abnormal liver function tests (LFTs) in post-liver transplant (LT) patients pose a challenge in the timing and selection of diagnostic modalities. There are little data regarding the accuracy of endoscopic retrograde cholangiopancreatography (ERCP) and liver biopsy (LB) in diagnosing post-transplant complications. AIM To evaluate the diagnostic performance of ERCP and LB in patients with non-vascular post-LT complications. METHODS This single-center retrospective study evaluated patients undergoing both ERCP and LB for evaluation of elevated LFTs within 6 mo of LT from 2000 to 2017. Diagnostic operating characteristics including accuracy, sensitivity and specificity for various diagnoses were calculated for ERCP and LB. The R factor (ratio of alkaline phosphatase to alanine aminotransferase) was also calculated for each patient. RESULTS Of the 1284 patients who underwent LT, 91 patients (74.7% males, mean age of 51) were analyzed. Anastomotic strictures (AS, 24.2%), acute cellular rejection (ACR, 11%) and concurrent AS/ACR (14.3%) were the most common diagnoses. ERCP carried an accuracy of 79.1% (95%CI: 69.3-86.9), LB had an accuracy of 93.4% (95%CI: 86.2-97.5), and the combination of the two had an accuracy of 100% (95%CI: 96-100). There was no difference between patients with AS and ACR in mean R factor (AS: 1.9 vs ACR: 1.1, P = 0.24). Adverse events did not differ between the two tests (ERCP: 3.1% vs LB: 1.1%, P = 0.31). CONCLUSION In patients with abnormal LFTs after LT without vascular complications, the combination of LB and ERCP carries low risk and improves diagnostic accuracy over either test alone.

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“…Despite significant advances in orthotopic liver transplantation (OLT), graft dysfunction continues to be a serious complication that is associated with high morbidity and mortality. 11,12 Biliary complications are the most common adverse events after OLT and can be seen in 10% to 25% of cases. 12 Hyperbilirubinemia is a serious, significant determinant of early graft dysfunction following OLT.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Biliary complications are the most common adverse events after OLT and can be seen in 10% to 25% of cases. 12 Hyperbilirubinemia is a serious, significant determinant of early graft dysfunction following OLT. Without recovery of the liver graft, the mortality from early graft dysfunction is high.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical embolic strokes in a liver transplant recipient with atrial septal defect undergoing therapeutic plasma exchange

Rodgers

Suneja

Yoshida

et al. 2020

J of Clinical Apheresis

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Therapeutic plasma exchange (TPE) is a technique used to separate blood components into layers based on their density difference, thus removing plasma and exchanging it with replacement fluids. A variety of adverse reactions has been described during TPE. Thrombotic events, especially strokes, are extremely rare complications of TPE. Our patient was a 55-year-old female with history of decompensated nonalcoholic steatohepatitis (NASH) liver cirrhosis. She underwent an orthotopic liver transplant (OLT) that was complicated with asystole during reperfusion. Cardiac workup revealed a new atrial septal defect (ASD) with left to right flow. Within the first 5 days after surgery, she developed refractory and persistent hyperbilirubinemia, with total bilirubin levels as high as 42 mg/dL. Our plasmapheresis service was consulted to initiate TPE. Towards

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A Review on the Management of Biliary Complications after Orthotopic Liver Transplantation

Cited by 68 publications

References 113 publications

Post-liver transplant biliary complications: Current knowledge and therapeutic advances

Post-liver transplant biliary complications: Current knowledge and therapeutic advances

Endoscopic retrograde cholangiopancreatography and liver biopsy in the evaluation of elevated liver function tests after liver transplantation

Paradoxical embolic strokes in a liver transplant recipient with atrial septal defect undergoing therapeutic plasma exchange

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