Late biliary tract complications after orthotopic liver transplantation: Diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography

Mosca, S; Militerno, Giuseppe; Guardascione, Maria Anna; Amitrano, Lucio; Picciotto, Francesco; Cuomo, O.

doi:10.1046/j.1440-1746.2000.02198.x

Cited by 48 publications

(32 citation statements)

References 13 publications

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“…It constituted 28 (40%) of biliary complications in our patient group and half of these presented between 4-12 mo post OLT. Use of ERC for treating anastomotic stricture in older studies had been disappointing [36,37] , however newer studies have reported the efficacy of endoscopic and percutaneous approaches in managing these complications [5,36,[38][39][40] . 2 failures of endoscopic treatment for anastomotic stricture in the present study had to undergo hepaticojejunostomy after 7 and 8 mo of OLT.…”

Section: Discussionmentioning

confidence: 99%

Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

Shastri

Hoepffner²,

Akoglu³

et al. 2007

WJG

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AIM:To correlate the significance of liver biochemical tests in diagnosing post orthotopic liver transplantation (OLT) biliary complications and to study their profile before and after endoscopic therapy. METHODS:Patients who developed biliary complications were analysed in detail for the clinical information, laboratory tests, treatment offered, response to it, follow up and outcomes. The profile of liver enzymes was determined. The safety, efficacy and outcomes of endoscopic retrograde cholangiography (ERC) were also analysed.RESULTS: 40 patients required ERC for 70 biliary complications. GGT was found to be > 3 times (388.1 ± 70.9 U/mL vs 168.5 ± 34.2 U/L, P = 0.007) and SAP > 2 times (345.1 ± 59.1 U/L vs 152.7 ± 21.4 U/L, P = 0.003) the immediate post OLT values. Most frequent complication was isolated anastomotic strictures in 28 (40%). Sustained success was achieved in 26 (81%) patients. CONCLUSION:Biliary complications still remain an important problem post OLT. SAP and GGT can be used as early, non-invasive markers for diagnosis and also to assess the adequacy of therapy. Endoscopic management is usually effective in treating the majority of these biliary complications.

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Section: Discussionmentioning

confidence: 99%

Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

Shastri

Hoepffner²,

Akoglu³

et al. 2007

WJG

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“…Biliary strictures may be anastomotic or non-anastomotic. Anastomotic biliary strictures are thought to result from technical surgical problems or local ischaemia; the incidence has been reported to be <10% for deceased donor liver transplantation, and to be higher, up to 30%, for living donor liver transplantation 153 154 155 156 157 158 159. Most anastomotic strictures appear within the first several months after transplantation, but they may also develop, less frequently, many years after transplantation.…”

Section: Later New-onset Diseases/injuries In the In Liver Allograftmentioning

confidence: 99%

Liver allograft pathology: approach to interpretation of needle biopsies with clinicopathological correlation

2009

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The spectrum of diseases encountered in post-transplant liver pathology biopsies is broad. In this review, these have been divided as belonging to one of three categories: (1) new-onset/de novo post-transplant abnormalities (early and late), (2) rejection, and (3) recurrence of original disease. The clinical and pathological features of the entities making up each category, with the relevant differential diagnosis and overlaps between and within these groups, are discussed and illustrated. Recurrent or de novo neoplasms make up a fourth category not included in this review. Early new-onset conditions are mostly related to surgical complications, donor factors and ischaemia to the graft. These include reperfusion/preservation injury, lipopeliosis, small-for-size-syndrome, biliary sludge syndrome and hepatic artery thrombosis. The various forms of rejection (cellular, chronic, antibody-mediated, and late atypical rejection) are detailed. Most chronic liver diseases can and do recur in the graft. They may display features that overlap with de novo conditions (eg, primary sclerosing cholangitis versus chronic rejection). As with most cases of allograft biopsy interpretation, accurate diagnosis rests with careful correlation of histological features with clinical, imaging and laboratory findings, and often comparison with previous sequential and follow-up biopsies. Late-onset new diseases include biliary strictures, idiopathic chronic hepatitis and de novo autoimmune hepatitis, among others. This review provides a practical approach to the interpretation of these challenging biopsies. Selected difficult scenarios or conundrums are identified and discussed in the relevant sections.

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“…Es werden zwei Entitäten von Strikturen unterschieden, die Anastomosenstenosen und die "ischemic type biliary lesions" (ITBL). Beide unterscheiden sich in ihrer Pathophysiologie und Prognose [5,7,8,9,12,13,14,15,16,17,18,20,21,22,23,24,25,26].…”

Section: Gallenwegsstrikturenunclassified

Cholangiopathien nach Lebertransplantation

Zöpf

Gerken

2007

Gastroenterologe

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Die Lebertransplantation hat sich zu einem Standardverfahren in der Therapie des fortgeschrittenen Leberversagens entwickelt. Kurz-und Langzeitüberleben sind inzwischen exzellent, mit Einjahresüberlebensraten von 80% und Fünfjahresüberlebens-raten von >70% [15, 20, 22, 23]. Seit Einführung der Lebertransplantation sind Cholangiopathien die häu-figste und wichtigste Komplikationtrotz entscheidender Fortschritte in der chirurgischen Technik und in der Posttransplantationsbetreuung. Die Häufigkeit biliärer Komplikationen wird mit 5-40% angegeben, realistisch erscheint eine Größenordnung von 20%. Von Bedeutung ist, dass das biliäre Epithel sehr viel empfindlicher gegenüber Ischämien zu sein scheint als das Leberparenchym [15, 20, 22, 23].

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Late biliary tract complications after orthotopic liver transplantation: Diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography

Abstract: These results confirms that ERCP is a valuable diagnostic tool and should be considered as the first step in the non-surgical management of late biliary tract complications after orthotopic liver transplantation.

Cited by 48 publications

References 13 publications

Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

Liver allograft pathology: approach to interpretation of needle biopsies with clinicopathological correlation

Cholangiopathien nach Lebertransplantation

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