CC chemokine receptor 5Δ32 polymorphism-a risk factor for ischemic-type biliary lesions following orthotopic liver transplantation

Moench, C.; Uhrig, A.; Lohse, Ansgar W.; Otto, Gerd

doi:10.1002/lt.20095

Cited by 71 publications

(64 citation statements)

References 31 publications

(35 reference statements)

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“…51 Investigation of the CCR5-D32 mutation in other forms of chronic liver disease is limited to hepatitis C and patients who have undergone liver transplantation. [52][53][54][55] In one of three studies on hepatitis C, the CCR5-D32 mutation was associated with significantly less portal inflammation but greater fibrosis, 52 while in the other two studies D32 was not associated with any specific outcomes in this population. 53,54 In contrast, analysis of CCR5-D32 in 146 patients undergoing liver transplantation for multiple different indications demonstrated a significant association between D32 and development of ischaemic-type biliary lesions postoperatively.…”

Section: Discussionmentioning

confidence: 83%

“…53,54 In contrast, analysis of CCR5-D32 in 146 patients undergoing liver transplantation for multiple different indications demonstrated a significant association between D32 and development of ischaemic-type biliary lesions postoperatively. 55 The functional significance of the CCR5-D32 mutation has been extensively investigated both in homozygotes and heterozygotes, and in association with infectious disease and inflammatory disease outcomes. Heterozygotes demonstrate reduced CCR5 expression, which is thought to be almost exclusively related to gene dosage and not receptor sequestration.…”

Section: Discussionmentioning

confidence: 99%

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CCR5-Δ32 mutation is strongly associated with primary sclerosing cholangitis

et al. 2004

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

CCR5-Δ32 mutation is strongly associated with primary sclerosing cholangitis

et al. 2004

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“…Also a genetic predetermination, e.g. the CCR5-32 mutation in recipients is supposed to be associated with an increased risk for NAS (60,61).…”

Section: Etiology and Clinical Manifestationmentioning

confidence: 99%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

253

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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“…Nineteen had to be admitted repeatedly for recurrent bacterial cholangitis (defined as 3 or more episodes). The median number of cholangitis episodes in these 19 was 5 (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Thirty patients were placed on maintenance antibiotic therapy, mostly ciprofloxacin, for some time.…”

Section: Cholangitis Episodesmentioning

confidence: 99%

Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression

et al. 2007

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Nonanastomotic biliary strictures (NAS) after orthotopic liver transplantation (OLT) are associated with high retransplant rates. The aim of the present study was to describe the treatment of and identify risk factors for radiological progression of bile duct abnormalities, recurrent cholangitis, biliary cirrhosis, and retransplantation in patients with NAS. We retrospectively studied 81 cases of NAS. Strictures were classified according to severity and location. Management of strictures was recorded. Possible prognostic factors for bacterial cholangitis, radiological progression of strictures, development of severe fibrosis/cirrhosis, graft survival, and patient survival were evaluated. Median follow-up after OLT was 7.9 years. NAS were most prevalent in the extrahepatic bile duct. Twenty-eight patients (35%) underwent some kind of interventional treatment, leading to a marked improvement in biochemistry. Progression of disease was noted in 68% of cases with radiological follow-up. Radiological progression was more prevalent in patients with early NAS and one or more episodes of bacterial cholangitis. Recurrent bacterial cholangitis (Ͼ3 episodes) was more prevalent in patients with a hepaticojejunostomy. Severe fibrosis or cirrhosis developed in 23 cases, especially in cases with biliary abnormalities in the periphery of the liver. Graft survival, but not patient survival, was influenced by the presence of NAS. Thirteen patients (16%) were retransplanted for NAS. In conclusion, especially patients with a hepaticojejunostomy, those with an early diagnosis of NAS, and those with NAS presenting at the level of the peripheral branches of the biliary tree, are at risk for progressive disease with severe outcome. Liver Transpl 13: [725][726][727][728][729][730][731][732] 2007. © 2007 AASLD.Received September 19, 2006; accepted February 15, 2007. Biliary complications are common after orthotopic liver transplantation (OLT). Biliary strictures and leakage of bile are most frequently encountered. Strictures are often referred to as anastomotic or nonanastomotic. Nonanastomotic biliary strictures (NAS) are generally considered to be the most troublesome type of biliary complications after liver transplantation, with a graft loss rate of up to 46% after 2 years. 1In a separate study, we have analyzed the radiological characteristics of NAS at the time of diagnosis and risk factors for the development of NAS.2 In this study, we were able to identify statistically significant differences in risk factors for the development of NAS depending on the time of initial presentation. In addition, large variations in anatomical localization and severity of NAS at the time of presentation were found, indicating that NAS is not a single disease but rather a group of biliary abnormalities with different pathogenesis. It is unAbbreviations: NAS, nonanastomotic biliary strictures; OLT, orthotopic liver transplantation; PTCD, percutaneous transhepatic cholangiodrainage; ERCP, endoscopic retrograde cholangiopancreaticography; RR, relati...

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CC chemokine receptor 5Δ32 polymorphism-a risk factor for ischemic-type biliary lesions following orthotopic liver transplantation

Cited by 71 publications

References 31 publications

CCR5-Δ32 mutation is strongly associated with primary sclerosing cholangitis

CCR5-Δ32 mutation is strongly associated with primary sclerosing cholangitis

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression

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