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

Mejía, Gilberto Stevan Moreno; Olarte-Parra, C.; Pedraza, Alexandra; Rivera, Jairo; Benavides, Carlos

doi:10.1016/j.transproceed.2016.02.033

Cited by 19 publications

(23 citation statements)

References 4 publications

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“…This is particularly indicated in cases with severe cholestasis and in allograft biopsies performed 6 months or more after transplantation, as demonstrated by the findings in our cohort. Previous studies have also indicated that the incidence of biliary complications increased with time after LT 9. In addition, most cases of sepsis occurred within 1 month after LT, which is consistent with previous findings by other groups 10.…”

Section: Discussionsupporting

confidence: 91%

Liver allograft biopsies with histological cholestasis: a clinicopathological study of 254 cases from a single centre

Chan

Chok

et al. 2017

J Clin Pathol

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AimsLiver 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.MethodsLiver allograft biopsies performed in Queen Mary Hospital, Hong Kong from 2004 to 2014 showing histological cholestasis were retrieved from the pathology archive. Clinical and pathological data were retrospectively reviewed and analyzed.ResultsAmong the 254 biopsies from 167 patients, large duct obstruction (LDO) and acute cellular rejection (ACR) were the two main aetiologies associated with cholestasis. There was a decrease in sepsis as a cause over the study duration. In cases showing cholestasis at 6 months or more after LT, LDO was more common than ACR. Over half (61%) of the 254 biopsies showed mild cholestasis. Severe panacinar cholestasis was more often observed in LDO. Mild cholestasis was most commonly observed regardless of the severity of ACR. Severe cholestasis was associated with poorer 1-year and 3-year graft survival and patient survival, as well as higher 3-month and 6-month post-biopsy mortality.ConclusionHistological cholestasis and its severity in liver allograft biopsies has clinical and prognostic significance. Our study summarizes our previous experience and provides further insights into the management of post-LT patients.

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Section: Discussionsupporting

confidence: 91%

Liver allograft biopsies with histological cholestasis: a clinicopathological study of 254 cases from a single centre

Chan

Chok

et al. 2017

J Clin Pathol

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“…Thus, the biggest problem is controlling infection to decrease posttransplant complications. Biliary complications are the primary morbidity in liver transplant patients, have an incidence of 10-30%, and even cause mortality (Mejia et al, 2016;Wojcicki, Milkiewicz & Silva, 2008), consistent with the 26% incidence of biliary tract in our study. The similarity of these results suggests that even though PBC affects small bile ducts, biliary complications have not dramatically increased.…”

Section: Discussionsupporting

confidence: 90%

The long-term outcomes of deceased-donor liver transplantation for primary biliary cirrhosis: a two-center study in China

Lin

Shi

et al. 2020

PeerJ

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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 posttransplantation. Recurrence, survival rate, and complications were recorded at follow-up. The effect of liver transplantation on survival and recurrence was evaluated using univariate and/or multivariate Cox regression analyses. Results In total, 69 patients with PBC undergoing DDLT were included in this study. At 4 weeks posttransplant, all liver function tests were normal. During a median follow-up time of 32 months, 5-year overall survival and recurrence rates were estimated as 95.1% and 21.8%, respectively. A recipient aspartate aminotransferase-to-platelet ratio index (APRI) greater than 2 was negatively associated with survival (P = 0.0018). Multivariate regression analysis demonstrated that age younger than 48 years was an independent risk factor for recurrent PBC in recipients undergoing liver transplantation (hazard ratio 0.028, 95% confidence interval 0.01–0.71, P = 0.03). Posttransplant infections (62%) and biliary tract complications (26%) were the most common complications. Conclusion Liver transplantation is an effective treatment for patients with PBC. Liver function normalizes by 4 weeks posttransplant. Although posttransplant survival rate is high, recurrence is possible. To some extent, survival rate and recurrence rate can be predicted by APRI and age, respectively.

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“…Thus, the biggest problem is controlling infection to decrease posttransplant complications. Biliary complications are the primary morbidity in liver transplant patients, have an incidence of 10-30%, and even cause mortality (Mejia et al 2016;Wojcicki et al 2008), consistent with the 26% incidence of biliary tract in our study. The similarity of these results suggests that even though PBC affects small bile ducts, biliary complications have not dramatically increased.…”

Section: Discussionsupporting

confidence: 90%

Peer Review #2 of "The long-term outcomes of deceased-donor liver transplantation for primary biliary cirrhosis: a two-center study in China (v0.1)"

2020

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and the First Central Hospital of Tianjin. Changes in liver function were assessed posttransplantation. Recurrence, survival rate, and complications were recorded at follow-up. The effect of liver transplantation on survival and recurrence was evaluated using univariate and/or multivariate Cox regression analyses. Results: In total, 69 patients with PBC undergoing DDLT were included in this study. At 4 weeks posttransplant, all liver function tests were normal. During a median follow-up time of 32 months, 5-year overall survival and recurrence rates were estimated as 95.1% and 21.8%, respectively. A recipient aspartate aminotransferase-to-platelet ratio index (APRI) greater than 2 was negatively associated with survival (P = 0.0018). Multivariate regression analysis demonstrated that age younger than 48 years was an independent risk factor for recurrent PBC in recipients undergoing liver transplantation (hazard ratio 0.028, 95% confidence interval 0.01-0.71, P = 0.03). Posttransplant infections (62%) and biliary tract complications (26%) were the most common complications. Conclusion: Liver transplantation is an effective treatment for patients with PBC. Liver function normalizes by 4 weeks posttransplant. Although posttransplant survival rate is high, recurrence is possible. To some extent, survival rate and recurrence rate can be predicted by APRI and age, respectively.

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

Cited by 19 publications

References 4 publications

Liver allograft biopsies with histological cholestasis: a clinicopathological study of 254 cases from a single centre

Liver allograft biopsies with histological cholestasis: a clinicopathological study of 254 cases from a single centre

The long-term outcomes of deceased-donor liver transplantation for primary biliary cirrhosis: a two-center study in China

Peer Review #2 of "The long-term outcomes of deceased-donor liver transplantation for primary biliary cirrhosis: a two-center study in China (v0.1)"

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