Liver transplantation for hepatolithiasis: Is terminal hepatolithiasis suitable for liver transplantation?

Abstract

Hepatolithiasis, originally as oriental cholangiohepatitis, especially prevails in Asia, but globalization and intercontinental migration have also converted the endemic disease dynamics around the world. Characterized by its high incidence of ineffective treatment and recurrence, hepatolithiasis, always, poses a therapeutic challenge to global doctors. Although the improved surgical and non-surgical techniques have evolved over the past decade, incomplete clearance and recurrence of calculi are always so common and disease-related mortality from liver failure and concurrent cholangiocarcinoma still exists in the treatment of hepatolithiasis. In the late stage of hepatolithiasis, is it suitable for liver transplantation (LT)? Herein, we propose a comprehensive review and analysis of the LTx currently in potential use to treat hepatolithiasis. In our subjective opinion, and as is objective from the literatures so far, also given the strict indications, LT remains one of the definitive treatments for terminal hepatolithiasis.

Recurrent Pyogenic Cholangitis as an Unusual Indication for Liver Transplantation in a Center of a Western Country

“…The therapeutic goals when the management of RPC should include: 1) control of the acute biliary sepsis ideally with decompression of the infected biliary tree (by percutaneous transhepatic biliary drainage or endoscopic sphincterotomy with or without biliary stent placement), 2) complete clearance of calculi and particulate debris from the biliary tract (via percutaneous transhepatic cholangioscopy lithotomy), 3) the elimination of bile stasis which is essential for preventing recurrent cholangitis and stone formation [4]. The management and the prognosis of RPC vary significantly, depending on the location and extent of the calculi, strictures, or abscesses in the biliary tree.…”

“…Recurrent pyogenic cholangitis (RPC), or previously called oriental cholangitis, is characterized by multiple strictures of the biliary tree, impaired biliary drainage, formation of intrahepatic biliary pigment stones and recurrent bouts of cholangitis. The disease is common in East Asia with prevalence ranging from 1,7% to 53,5% but is rare in the West with prevalence in the range of 0,6-1,3% [1][2][3][4][5][6][7]. It occurs with equal frequency in men and women with a peak incidence between the third and fourth decades of life, although it can also be seen in patients over the age of 60.…”

Hepatolithiasis: Epidemiology, presentation, classification and management of a complex disease

“…As long-standing hepatolithiasis may be characterised by repeated episodes of cholangitis, liver abscesses and liver atrophy, it can consequentially lead to secondary biliary cirrhosis with portal hypertension and liver failure[ 49 , 111 ]. In this setting, OLT is an option, even though relevant experience is scarce, with no more than 30 cases reported[ 49 , 111 - 113 ]. However, all patients transplanted for hepatolithiasis had favourable long-term outcomes, with the majority having developed secondary biliary cirrhosis prior to OLT[ 49 , 111 - 113 ].…”

“…In this setting, OLT is an option, even though relevant experience is scarce, with no more than 30 cases reported[ 49 , 111 - 113 ]. However, all patients transplanted for hepatolithiasis had favourable long-term outcomes, with the majority having developed secondary biliary cirrhosis prior to OLT[ 49 , 111 - 113 ]. Postoperative complications were not uncommon, but no mortality has been recorded[ 49 , 111 - 113 ].…”

Step-by-step strategy in the management of residual hepatolithiasis using post-operative cholangioscopy

“… 20 Though surgical techniques and peri-operative management could fully meet the needs of liver transplantation, only 27 successful cases have been reported in four centres since 2002. 30 CBDE has been experimentally proved to be a potentially effective therapeutic approach for treating and preventing the recurrence of hepatolithiasis. 31 It is rarely used in clinical practice, except for two cases reported in 2008.…”