Biliary stones and sludge in liver transplant patients: a 13-year experience.

Sheng, Rubin; Ramirez, Carlo B.; Zajko, Albert B.; Campbell, William L.

doi:10.1148/radiology.198.1.8539387

“…2,3 BCS is reported to occur in 4%-18% of orthotopic liver transplant (OLT) patients. [4][5][6][7] There have been only 2 reported cases of BCS in nontransplant patients. 8 With respect to OLT patients, BCS is associated with increased morbidity, mortality, and rejection of the graft.…”

Section: See Editorial On Page 1400mentioning

confidence: 99%

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

Gor

¹

,

Levy

²

,

Ahn

³

et al. 2008

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Biliary cast syndrome (BCS), the presence of biliary casts and debris causing biliary obstruction, occurs in 4%-18% of orthotopic liver transplant (OLT) recipients. Potential consequences include cholangitis and graft damage or loss. Limited data exist regarding the etiology and outcomes of BCS. The purpose of this study was to evaluate donor and recipient risk factors and determine the impact of BCS. A retrospective review of 355 OLT cases identified 9 BCS patients (2.5%) diagnosed by cholangiography. Twenty-six matched controls were also identified. The warm ischemic time was significantly longer in BCS patients. Other recipient and donor preoperative and intraoperative characteristics, including the donor risk index, revealed no significant differences. Overall patient survival showed a trend toward worse outcomes at 6, 12, and 18 months and end of follow-up in the BCS group. Overall graft survival was also worse in the BCS group at all time periods, with statistical significance demonstrated at 18 months and end of follow-up. The number of therapeutic biliary procedures and hospital readmissions was significantly higher in the BCS group. Twenty-two percent of the BCS patients required repeat OLT versus none of the control patients. In conclusion, BCS is an uncommon complication of OLT. Except for a longer warm ischemic time, recipient and donor factors did not predict the occurrence of BCS. BCS patients showed a significantly worse graft survival, as well as a trend toward worse patient survival. Given the negative impact of BCS on liver transplant outcomes, further studies appear justified.

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“…In the Shah et al 6 series, ischemia factors were present in 70% of cast patients versus 15% of controls. Sheng et al 1 have reported a relatively close association (30% of cases) between the occurrence of hepatic artery thrombosis and sludge formation after transplantation. In the same study involving 53 patients with sludge/casts after LT, the average cold ischemia time was 12.6 hours.…”

Section: Inflammatory Picturementioning

confidence: 94%

Bile duct stones and casts after liver transplantation: Different entities but similar prevention strategy?

Cillo

¹

,

Burra

²

,

Norberto

³

et al. 2008

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Biliary cast syndrome (BCS), the presence of biliary casts and debris causing biliary obstruction, occurs in 4%-18% of orthotopic liver transplant (OLT) recipients. Potential consequences include cholangitis and graft damage or loss. Limited data exist regarding the etiology and outcomes of BCS. The purpose of this study was to evaluate donor and recipient risk factors and determine the impact of BCS. A retrospective review of 355 OLT cases identified 9 BCS patients (2.5%) diagnosed by cholangiography. Twenty-six matched controls were also identified. The warm ischemic time was significantly longer in BCS patients. Other recipient and donor preoperative and intraoperative characteristics, including the donor risk index, revealed no significant differences. Overall patient survival showed a trend toward worse outcomes at 6, 12, and 18 months and end of follow-up in the BCS group. Overall graft survival was also worse in the BCS group at all time periods, with statistical significance demonstrated at 18 months and end of follow-up. The number of therapeutic biliary procedures and hospital readmissions was significantly higher in the BCS group. Twenty-two percent of the BCS patients required repeat OLT versus none of the control patients. In conclusion, BCS is an uncommon complication of OLT. Except for a longer warm ischemic time, recipient and donor factors did not predict the occurrence of BCS. BCS patients showed a significantly worse graft survival, as well as a trend toward worse patient survival. Given the negative impact of BCS on liver transplant outcomes, further studies appear justified

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“…Types 5 and 6: the bile duct epithelium is greatly damaged, the formed BC and necrosis floss fill in the bile duct; a complete profile cannot be displayed by contrast, only the residual trunk is visible. Cholangiography is believed to be the criterion standard for BC diagnosis, 14,15 showing the filling defect of the biliary tree. In addition, potential BC characters in biliary duct can be estimated.…”

Section: Clinical Manifestations Of Different Pathotypes Of the Biliamentioning

confidence: 99%

Pathotyping and Clinical Manifestations of Biliary Cast Syndrome in Patients After an Orthotopic Liver Transplant

Zhu¹,

Shen²,

Chen³

et al. 2013

Exp Clin Transplant

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Objectives: To summarize the pathotyping and clinical manifestations of biliary cast syndrome in patients after an orthotopic liver transplant. Materials and Methods:The clinical manifestations, auxiliary examination, therapeutic regimen, and clinical efficacy of 103 biliary cast syndrome patients who underwent an orthotopic liver transplant were retrospectively analyzed. Patients were divided into 6 groups from type 1 to type 6, according to the injury level of the biliary duct epithelium. Results: Many biliary cast syndrome patients showed symptoms including jaundice, dark urine, argillaceous stool, itchy skin, and fever. Serum levels of alanine aminotransferase, γ-glutamyl transpeptidase, alkaline phosphatase, and total bilirubin were increased. In addition, total white cell counts in peripheral blood also were increased. T-tube cholangiography showed filling defects of various amounts. Optical fiber choledochoscope examination revealed that the biliary tract was filled with solid substances, and necrosis of the biliary tract epithelium was observed in some biliary cast syndrome patients. From type 1 to type 6 biliary cast syndrome patients, the probability of clinical symptoms and biliary tract stricture gradually increased, the time needed for supporting gradually prolonged after removal of the biliary cast, and T-tube cholangiography showed that the filling defects gradually expanded. Conclusions:Clinical manifestations and cholangiography presentations mainly depend on pathotyping.

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Biliary stones and sludge in liver transplant patients: a 13-year experience.

Cited by 90 publications

References 0 publications

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

Bile duct stones and casts after liver transplantation: Different entities but similar prevention strategy?

Pathotyping and Clinical Manifestations of Biliary Cast Syndrome in Patients After an Orthotopic Liver Transplant

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