Biliary Complications After Orthotopic Liver Transplantation: The Hungarian Experience

Gámán, György; Gelley, Fanni; Doros, Attila; Zádori, Gergely; Görög, Dénes; Fehérvári, Imre; Kopper, László; Nemes, Balázs

doi:10.1016/j.transproceed.2013.10.009

Cited by 19 publications

(8 citation statements)

References 12 publications

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“…Liver transplantation (LT) is the only curative treatment for end‐stage liver disease. Despite the many technical improvements, surgical complications, especially biliary (20%‐30%) and arterial (10%‐15%) complications, are still common. Although there are many recipient‐ and donor‐related risk factors for arterial complications, we believe that technical difficulties are the most significant cause.…”

mentioning

confidence: 99%

The recipient celiac trunk as an alternative to the native hepatic artery for arterial reconstruction in adult liver transplantation

Dokmak¹,

Aussilhou²,

Landi³

et al. 2015

Liver Transpl

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During liver transplantation (LT), the recipient hepatic artery (RHA) cannot always be used, and alternatives include aortohepatic conduits and the splenic artery (SA). We report our experience with arterial reconstruction on the recipient celiac trunk (RCT), which has rarely been described. Since January 2013, we have been using the RCT when the RHA could not be used. All cases were discussed in a multidisciplinary LT meeting, and arterial patency or anomalies were systemically viewed with computed tomography (CT) scan. The RCT was used after section-ligation of all celiac trunk collaterals. Until May 2014, the RHA could not be used in 11/139 (8%) patients who underwent LT. Postoperative arterial patency was assessed by serial Doppler ultrasound and CT scan. The advantages and disadvantages of the different arterial conduits were evaluated. The RCT was used in 7/11 (64%) patients. Mean follow-up was 10 (6-15) months. The patency rate was 100%, and 1 patient with associated portal shunting died at day 20 from septic complications. No related gastric or splenic complications were encountered. The RCT could not be used in 4 patients with reconstruction on the SA (n 5 2), infrarenal (n 5 1), and supraceliac aorta (n 5 1). The patency rate was 75%. One patient with SA conduit and portal shunting developed pancreatitis/anastomotic pseudoaneurysm with secondary rupture. An emergency infrarenal conduit was created, which was later embolized because of infected pseudoaneurysms. Although the literature reports a higher risk of thrombosis with aortohepatic conduits, no long-term results are available for the SA conduits, and only 1 report is available for the RCT. In conclusion, this study shows that the RCT is a good alternative to the RHA and can be used in two-thirds of patients with inadequate RHA flow.

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mentioning

confidence: 99%

The recipient celiac trunk as an alternative to the native hepatic artery for arterial reconstruction in adult liver transplantation

Dokmak¹,

Aussilhou²,

Landi³

et al. 2015

Liver Transpl

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“…Reanastomosis was reserved for treatment failure and retransplantation for hepatic artery thrombosis. Endoscopic or percutaneous procedures had resolution in 45% of patients with biliary complications [26][27][28]. The resolution of the biliary complication by hepatic retransplantation was 25.0%.…”

Section: Discussionmentioning

confidence: 98%

“…Literary work has shown that most stenoses were treated primarily with dilatation of the balloon bile duct, both endoscopically and percutaneously [26][27][28]. Fistulas had a higher proportion of primary surgical treatment (17.6%); however, the main form of management was still the endoscopic or percutaneous placement of intra-bile prostheses and drains.…”

Section: Discussionmentioning

confidence: 99%

Epidemiologic Study on the Incidence of Biliary Complications after Liver Transplantation

Silva¹,

Andrade²,

Lisboa³

et al. 2018

J Liver

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Introduction: Biliary complications after hepatic transplantation have a variable incidence of 10 to 25% among all complications after hepatic transplantation and mortality reported up to 10%, have an important impact on the patient's quality of life, since it implies the need for hospitalizations and multiple interventions for treatment. They are more frequent in the first year after transplantation, with progressive reduction of the frequency after 1 year. Objective: To evaluate the risk factors of greater impact in the development of bile duct stenosis in patients after liver transplantation. Methods: One hundred and eighty-eight charts of liver transplant patients were retrospectively evaluated. Inclusion criteria: liver transplanted patients from 2011 to December 2017. Exclusion criteria: deaths that occurred between the first month after transplantation, incomplete medical records and most cases of retransplants, except for patients who retransplanted as a consequence of their own complication. Results: Biliary complications were present in 14% (N=26) of the patients. Of these, 52% (N=21) presented stenosis of the biliary tract, followed by other complications such as cholangitis (20%), fistula calculation (10%), bilioma (3%). Among patients with bile duct stenosis, 19% (N=4) presented non-anastomotic stenosis and 81% (N=17) anastomotic stenosis. The cause of hepatopathy was in 42% of patients (N=9) ethanolic, followed by other causes such as: viral hepatitis, cryptogenic, autoimmune, fulminant hepatitis, NASH, CEP, glycogenosis and 1 case of secondary retransplantation to the bile complication itself. Conclusion: The incidence of biliary complications is comparable with the incidence reported in other institutions. The low incidence of bile duct stenosis reduces the power of the study to identify the most impacting risk factors.

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“…Moreover, there is an urgent need for newer technology to better manage the key problems that are associated with liver transplantation, which represent a specific need for further development. [ 10 ]…”

Section: Discussionmentioning

confidence: 99%

Biliary Cast Syndrome

Tian

Liao

et al. 2015

Chinese Medical Journal

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Background:Biliary cast syndrome (BCS) was a postoperative complication of orthotopic liver transplantation (OLT), and the reason for BSC was considered to relate with ischemic type biliary lesions. This study aimed to evaluate the relationship between BCS following OLT and the hepatic artery resistance index (HARI), and to observe pathological changes and morphology of biliary casts.Methods:Totally, 18 patients were diagnosed with BCS by cholangiography following OLT using choledochoscope or endoscopic retrograde cholangiopancreatography. In addition, 36 patients who did not present with BCS in the corresponding period had detectable postoperative HARI on weeks 1, 2, 3 shown by color Doppler flow imaging. The compositions of biliary casts were analyzed by pathological examination and scanning electron microscopy.Results:HARI values of the BCS group were significantly decreased as compared with the non-BCS group on postoperative weeks 2 and 3 (P < 0.05). Odds ratio (OR) analysis of HARI 1, HARI 2, HARI 3 following the operation was >1 (OR = 1.300; 1.223; and 1.889, respectively). The OR of HARI 3 was statistically significant (OR = 1.889; 95% confidence interval = 1.166–7.490; P = 0.024). The compositions of biliary casts were different when bile duct stones were present. Furthermore, vascular epithelial cells were found by pathological examination in biliary casts.Conclusions:HARI may possibly serve as an independent risk factor and early predictive factor of BCS. Components and formation of biliary casts and bile duct stones are different.

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Biliary Complications After Orthotopic Liver Transplantation: The Hungarian Experience

Cited by 19 publications

References 12 publications

The recipient celiac trunk as an alternative to the native hepatic artery for arterial reconstruction in adult liver transplantation

The recipient celiac trunk as an alternative to the native hepatic artery for arterial reconstruction in adult liver transplantation

Epidemiologic Study on the Incidence of Biliary Complications after Liver Transplantation

Biliary Cast Syndrome

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