Early Biliary complications after liver transplantation

Daniel, Kimberly E.; Said, Adnan

doi:10.1002/cld.654

Cited by 28 publications

(21 citation statements)

References 20 publications

(87 reference statements)

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“…The most common complication in our study involved biliary complications. The incidence of biliary complications in liver recipients varies from 10% to 15% in DDLT and from 15% to 30% in LDLT [ 12 ]. The rate of biliary complications in our study was 32.8%.…”

Section: Discussionmentioning

confidence: 99%

Liver Transplantation: A 10-Year Low-Volume Transplant Center Experience in Kazakhstan

et al. 2021

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Background Liver transplantation is considered to be the best available treatment option for patients with liver failure. In Kazakhstan, the liver transplantation program was established a decade ago. In this study, we analyzed a low-volume transplant center experience of liver transplantation in Kazakhstan. Material/Methods Clinical data of the 64 consecutive liver transplantations from deceased and living donors between 2010 and 2020 were retrieved from electronic records. All data were retrospectively analyzed. Results A total of 64 liver transplantations, 11 from deceased donors and 53 from living donors, were carried out in our center between 2010 and 2020. The mean age of the recipient was 44 years, 53% were female, and 47% were male. Hepatitis B+hepatitis D infection was the most common cause of end-stage liver disease (21 cases; 32.8%). The overall patient survival rates for 1, 3, and 5 years were 75%, 69.5%, and 59.6%, respectively, for recipients of a liver transplant from a living donor and 54.5%, 45.5%, and 39% for recipients of a liver transplant from a deceased donor. Conclusions Our clinical outcomes had a high rate of biliary and vascular complications that led to a low survival rate of the recipients. Starting the transplant program in Kazakhstan faced various challenges. In the early period, most transplantations were performed in collaboration with or under the guidance of transplant teams from Russia, Turkey, and South Korea. Improving surgical techniques and protocols of pre- and posttransplantation management could reduce the complications after transplantation.

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Section: Discussionmentioning

confidence: 99%

Liver Transplantation: A 10-Year Low-Volume Transplant Center Experience in Kazakhstan

et al. 2021

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“…(19) yaptığı çalışmada, hepatoektomi sonrası biliyer kaçakları cerrahi olmayan yollarla yönetilebilir olduğunu gösterdi . Radyolojik ve endoskopik tekniklerdeki gelişmeler, nakil sonrası popülasyonda biliyer komplikasyonlar için tanı ve tedavi stratejilerini değiştirmiştir (20).…”

Section: Discussionunclassified

“…ERKP girişimi, biliyer komplikasyonlarda ilk tedavi seçeneği olmasına ragmen canlı donör karaciğer nakli alıcılarında, çok kompleks safra yolu rekonstrüksiyonu nedeni ile yüksek bir başarısızlık oranına sahiptir (16)(17)(18)(19)(20). Merkezimizde safra kaçağı olan 23 hasta (%85) girişimsel radyolojik yaklaşımlar (PTBD ve PD) ile tedavi edildi, Tüm olgularda kateter biliyer ağaçta en fazla 9 ay tutuldu.…”

Section: Discussionunclassified

Canli Donör Karaci̇ğer Naki̇l Sonrasi Bi̇li̇yer Kaçaklarin Perkütan Tedavi̇si̇

Server¹,

Güven²

2019

J Istanb Fac Med

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“…1 The clinical presentation of biliary complications in liver transplant recipients is often atypical due to pharmacological immunosuppression, alteration of anatomy, and denervation of the allograft. 2 As the use of extended criteria and marginal allografts rises, the incidence of bile duct strictures is expected to increase. 3,4 Liver transplant recipients are debilitated, have multiple comorbidities, and are hence at risk of requiring inpatient care.…”

Section: Introductionmentioning

confidence: 99%

“…These strictures and the associated cholangiopathy can lead to cholangitis, cast formation, and other adverse outcomes 1 . The clinical presentation of biliary complications in liver transplant recipients is often atypical due to pharmacological immunosuppression, alteration of anatomy, and denervation of the allograft 2 . As the use of extended criteria and marginal allografts rises, the incidence of bile duct strictures is expected to increase 3,4 …”

Section: Introductionmentioning

confidence: 99%

Patients with post‐transplant biliary strictures have significantly higher rates of liver transplant failure and rejection: A nationwide inpatient analysis

Kohli

Desai

Kennedy

et al. 2021

J of Gastro and Hepatol

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Background and Aim: Biliary strictures are a common complication of liver transplantation. We assess the impact of post-transplant biliary strictures and describe the outcomes of endoscopic retrograde cholangiopancreatography (ERCP), interventional radiology (IR), and surgical therapies. Methods: Using the Nationwide Readmissions Database (NRD), hospitalized liver transplant recipients were identified using the International Classification of Diseases 10th Revision codes. Patients with post-transplant biliary strictures were identified, and outcomes (inpatient mortality, 30-day readmission, transplant rejection/infection/failure, and disposition) were compared with transplant recipients without strictures. Among transplant patients with biliary strictures who underwent therapeutic intervention, corresponding outcomes were compared between IR, surgical interventions, and ERCP. Results: Of the 8300 liver transplant recipients meeting selection criteria, 554 patients (age 48.9 ± 18.2 years, mean ± SD; 39.5% women) had biliary strictures. Compared with patients without strictures, the adjusted odds ratio (OR) for various outcomes in patients with biliary strictures were as follows: 1.46 (1.20, 1.77; P < 0.001) for 30-day nonelective readmission, 2.71 (2.04, 3.59; P < 0.001) allograft rejection, 2.32 (1.61, 3.37; P < 0.001) liver transplant failure, 3.05 (1.39, 6.73; P < 0.01) infection, and 1.41 (1.08, 1.82; P = 0.01) disposition to skilled nursing or intermediate care facility. Therapeutic interventions during index hospitalization were performed in 350 patients: ERCP 46.6% (n = 163), surgery 41% (n = 144), and IR 12.3% (n = 43) patients. Compared with ERCP, the adjusted odds for various outcomes were disposition to skilled nursing or intermediate care facility 2.72 (1.08, 6.87; P = 0.03) and 2.09 (1.05, 4.15; P = 0.036), prolongation of hospitalization 14.4 (3.7, 25.1; P = 0.008) and 15.0 (7.4, 22.7; P < 0.001), and failure of liver allograft 8. 47 (1.47, 48.6; P = 0.017) and 12.23 (2.74, 54.4; P = 0.001) for IR and surgical interventions, respectively. Conclusion: Post-liver transplant biliary strictures are associated with increased rates of allograft rejection, allograft failure/infections, and readmissions. Compared with ERCP, management of these patients with IR or surgical interventions is associated with significantly higher rates of allograft failure and hospital stay.

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Early Biliary complications after liver transplantation

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/10-3-reading-daniel.html a video presentation of this article

Cited by 28 publications

References 20 publications

Liver Transplantation: A 10-Year Low-Volume Transplant Center Experience in Kazakhstan

Liver Transplantation: A 10-Year Low-Volume Transplant Center Experience in Kazakhstan

Canli Donör Karaci̇ğer Naki̇l Sonrasi Bi̇li̇yer Kaçaklarin Perkütan Tedavi̇si̇

Patients with post‐transplant biliary strictures have significantly higher rates of liver transplant failure and rejection: A nationwide inpatient analysis

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