Management of anastomotic biliary stricture after liver transplantation and impact on survival

Jarlot-Gas, Cécile; Muscari, Fabrice; Mokrane, Fatima-Zohra; Bello, Arnaud Del; Culetto, Adrian; Buscail, Étienne; Péré, Guillaume; Farés, Nadim; Péron, Jean‐Marie; Cuellar, Emmanuel; Barange, Karl; Kamar, Nassim; Suc, B.; Maulat, Charlotte

doi:10.1016/j.hpb.2020.12.008

Cited by 13 publications

(16 citation statements)

References 46 publications

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“…Second, the occurrence of ABS did not negatively impact long-term survival. This observation is in line with other series ( 3 , 40 , 41 ). Yet, a recent large study showed the negative impact of early anastomotic biliary complication occurring within the first 3 months after LT ( 42 ).…”

Section: Discussionsupporting

confidence: 93%

“…More importantly, the predominant role of postoperative events on the development of ABS has to be highlighted. Regarding the association between the occurrence of anastomotic biliary fistula and the development of ABS, this relationship has been previously shown in various series ( 3 , 18 , 19 ). Anastomotic biliary fistula would indeed cause local inflammation, eventually leading to local fibrosis at the site of healing, resulting in ABS.…”

Section: Discussionsupporting

confidence: 52%

“…Instead, three independent risk factors have been identified. Although the protective role of high donor BMI on the occurrence of ABS remains difficult to discuss, Jarlot-Gas et al recently reported the same association ( 3 ). One could hypothesize that high donor BMI is related to large graft bile duct, resulting in less difficult biliary reconstruction.…”

Section: Discussionmentioning

confidence: 95%

“…Regarding ABS management and impact on survival, the current study confirmed findings from a large body of the previously published literature. First, ABS endoscopic management was effective in most cases as a first-line approach with a recurrence rate around 20% ( 3 , 35 – 38 ). Further, even in case of ABS recurrence, repeat endoscopic treatment allowed a successful treatment in most cases, thereby obviating the need for percutaneous transhepatic or surgical treatment ( 35 , 39 ).…”

Section: Discussionmentioning

confidence: 99%

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Post-Transplantation Cytomegalovirus Infection Interplays With the Development of Anastomotic Biliary Strictures After Liver Transplantation

Georges¹,

Clerc²,

Turco³

et al. 2022

Transpl Int

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Background: Anastomotic biliary stricture (ABS) remains the most frequent complication after liver transplantation (LT). This study aimed to identify new anastomotic biliary stricture risk factors, with a specific focus on postoperative events. Additionally, ABS management and impact on patient and graft survival were assessed.Methods: All consecutive patients who underwent LT with duct-to-duct anastomosis between 2010 and 2019 were included. All patients who died within 90 days after LT due to non-ABS-related causes were excluded.Results: Among 240 patients, 65 (27.1%) developed ABS after a median time of 142 days (range, 13–1265). Median follow-up was 49 months (7–126). Upon multivariable analysis, donor BMI (OR=0.509, p = 0.037), post-LT CMV primoinfection (OR = 5.244, p < 0.001) or reactivation (OR = 2.421, p = 0.015) and the occurrence of post-LT anastomotic biliary fistula (OR = 2.691, p = 0.021) were associated with ABS. Anastomotic technical difficulty did not independently impact the risk of ABS (OR = 1.923, p = 0.051). First-line ABS treatment was systematically endoscopic (100%), and required a median of 2 (range, 1–11) procedures per patient. Repeat LT was not required in patients developing ABS. The occurrence of ABS was not associated with overall patient survival (p = 0.912) nor graft survival (p = 0.521).Conclusion: The risk of developing ABS after LT seems driven by the occurrence of postoperative events such as CMV infection and anastomotic fistula. In this regard, the role of CMV prophylaxis warrants further investigations.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Post-Transplantation Cytomegalovirus Infection Interplays With the Development of Anastomotic Biliary Strictures After Liver Transplantation

Georges¹,

Clerc²,

Turco³

et al. 2022

Transpl Int

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“…Cholestasis leads to impaired liver function; only a few patients can be successfully treated by endoscopic stents and drainage tubes or surgical treatment. However, most patients still lack safe and effective treatment measures [ 2 – 4 ]. Therefore, preventing and treating biliary complications after liver transplantation is an urgent clinical problem to be solved.…”

Section: Introductionmentioning

confidence: 99%

IL-22 Protects against Biliary Ischemia-Reperfusion Injury after Liver Transplantation via Activating STAT3 and Reducing Apoptosis and Oxidative Stress Levels In Vitro and In Vivo

Bai

Zhang

et al. 2022

Oxidative Medicine and Cellular Longevity

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Biliary complications are currently one of the leading causes of liver failure and patient death after liver transplantation and need to be solved urgently. Biliary ischemia-reperfusion injury (IRI) is one of the important causes of biliary complications. IL-22 has a protective effect on liver injury and hepatitis diseases, and its safety and efficacy in the treatment of hepatitis have also been proved in human clinical experiments. Furthermore, multiple studies have confirmed that IL-22 promotes the proliferation and repair of epithelial cells in various organs. Still, its function in the bile duct after transplantation has not been explored. This study was aimed at investigating the effects of IL-22 on cholangiocyte IRI in vitro and in vivo and exploring its underlying mechanisms. We simulated the hypoxia process of bile duct epithelial cells through in vitro experiments to investigate the protective function and molecular mechanism of IL-22 on bile duct epithelial cells. Subsequently, the function and mechanism of IL-22 in the biliary IRI model of autologous orthotopic liver transplantation in rats were assessed. This study confirmed that IL-22 could promote cholangiocyte proliferation, decrease the apoptosis rate of cholangiocytes and tissues, decrease MDA levels, and increase SOD levels by activating STAT3. In addition, IL-22 can also reduce the level of mitochondrial membrane depolarization, protect mitochondria, reduce ROS production, and play a role in protecting bile ducts. These findings provide evidence for IL-22 as a novel and effective treatment for biliary IRI after liver transplantation.

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Management of anastomotic biliary stricture through utilizing percutaneous transhepatic cholangioscopy

Yasen,

Feng,

Dai

et al. 2024

Clinical Radiology

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Management of anastomotic biliary stricture after liver transplantation and impact on survival

Cited by 13 publications

References 46 publications

Post-Transplantation Cytomegalovirus Infection Interplays With the Development of Anastomotic Biliary Strictures After Liver Transplantation

Post-Transplantation Cytomegalovirus Infection Interplays With the Development of Anastomotic Biliary Strictures After Liver Transplantation

IL-22 Protects against Biliary Ischemia-Reperfusion Injury after Liver Transplantation via Activating STAT3 and Reducing Apoptosis and Oxidative Stress Levels In Vitro and In Vivo

Management of anastomotic biliary stricture through utilizing percutaneous transhepatic cholangioscopy

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