Incidence and risk factors for the development of prolonged and severe intrahepatic cholestasis after liver transplantation

Abstract

Predictive factors for intrahepatic cholestasis after orthotopic liver transplantation (OLT) have not yet been established. We sought to identify the incidence and risk factors associated with prolonged severe intrahepatic cholestasis (PSIC) after OLT. We assessed 428 consecutive patients undergoing their first OLT. PSIC was diagnosed if a serum bilirubin concentration was greater than 100 mol/L and/or a 3-fold increase of alkaline phosphatase occurred within the first month after OLT and was sustained for at least 1 week in the absence of biliary complications. Multivariable logistic regression identified factors independently associated with PSIC. PSIC developed in 107 patients (25%). Independent risk factors by multivariable analysis were intraoperative transfusion of cryoprecipitate and platelets; nonidentical blood group status; suboptimal organ appearance; inpatient status before transplantation; and bacteraemia in the first month after transplantation. In contrast, acute liver failure, older age, and higher levels of serum sodium and serum potassium were all associated with a reduced likelihood of developing PSIC in the first month. There were 47 deaths in the PSIC group (44%) as opposed to 65 deaths in the non-PSIC group (20%) after OLT. A poor preoperative clinical status in conjunction with a suboptimal graft was associated with PSIC after OLT. Avoidance of suboptimal livers and ABO nonidentical grafts for young patients with poor synthetic function and for pretransplant inpatients may lessen this complication and reduce the associated early mortality.

Intraoperative Cryoprecipitate Transfusion and Its Association with the Incidence of Biliary Complications after Liver Transplantation-A Retrospective Cohort Study

“…Due to improvement in surgical techniques and perioperative care, the incidence of biliary anastomosis strictures and leaks decreased, however the incidence of non-anastomotic bile duct stricture became more apparent [4], [5]. Previous studies in LT have found that apart from the obvious life-saving benefits, an increase in blood loss and subsequent transfusion of blood products has been associated with substantial side effects, such as increased risk of BC [6] [7].…”

Primary Graft Dysfunction After Living Donor Liver Transplantation Is Characterized by Delayed Functional Hyperbilirubinemia

“…Even in pediatric LDLT, Emond et al (21) reported that cholestasis was more prominent and was prolonged in recipients with smaller LDLT grafts. Although studies evaluating prolonged hyperbilirubinemia in DDLT are limited, Fusai et al (22) reported that functional hyperbilirubinemia >100 lmol/L sustained for at least 1 week after DDLT was associated with poor prognosis. After hepatic resection for tumors, Balzan et al (23) showed that PT <50% and T.Bil >50 lmol/L on POD 5 is associated with a mortality rate exceeding 50% after hepatectomy.…”

Role of Nutrition in the Management of Hepatic Encephalopathy in End-Stage Liver Failure

“…Alterations in markers of nutritional status such as serum albumin are significant risk factors for both surgical [71] and postsurgical [72] complications of liver transplantation. Moreover, it has been suggested that nonabsorbable disaccharides (such as lactulose) administered for the management of HE may result in intestinal malabsorption in patients with end-stage liver failure with the potential to result in poor transplant outcome [73].…”