Prolonged Cold Ischemic Time Is a Risk Factor for Biliary Strictures in Duct-to-Duct Biliary Reconstruction in Living Donor Liver Transplantation

Park, Jae Berm; Kwon, Choon Hyuck David; Choi, Gyu‐Seong; Chun, Jae Min; Jung, Guhung; Kim, Jong Man; Joh, Jae‐Won; Lee, Suk-Koo

doi:10.1097/tp.0b013e31818b2316

Cited by 76 publications

(64 citation statements)

References 22 publications

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“…Nevertheless, the overall biliary morbidity in most series is still between 10% and 30% (100,(107)(108)(109). A considerably lower rate has been reported in newer analyses; however long-term data remain to be awaited, since many stenoses manifest several years after LDLT.…”

Section: Anastomotic Complications After Ldltmentioning

confidence: 99%

“…It is well known, that size and number of donor bile ducts are the major determinants of biliary complications after LDLT (100,101). One analysis revealed even a sixfold increased risk of biliary complications in the case of more than one biliary orifice (102).…”

Section: Prophylaxis Of Biliary Complications In Ldltmentioning

confidence: 99%

“…Conversion from duct-to-duct to Roux-Y might be useful in selected cases (100), in the case of severe graft damage retransplantation might be considered.…”

Section: Nonanastomotic Complications After Ldltmentioning

confidence: 99%

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Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

251

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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Section: Anastomotic Complications After Ldltmentioning

confidence: 99%

Section: Prophylaxis Of Biliary Complications In Ldltmentioning

confidence: 99%

See 1 more Smart Citation

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

251

233

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“…Other risk factors for BAS identified in multivariate analyses include donor age [50 years [8], preoperative MELD score C35 [27], urgency of the surgery [33], bile duct diameter [34], a graft with multiple bile ducts [31], graft cold ischemia time [24,34], hepatic artery stenosis [31], and acute cellular rejection [24]. Whether the biliary reconstruction technique affects the development of BAS is controversial.…”

Section: Etiologies and Risk Factors For Biliary Strictures After Ldltmentioning

confidence: 99%

Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP. Endoscopic management of biliary strictures is technically more challenging in LDLT than in DDLT because of the complexity of the biliary anastomosis, in addition to the tortuous and angulated biliary system. Placement of one or more plastic stents after balloon dilation has been the standard strategy for post-LDLT stricture, but this requires multiple stent exchange to prevent stent occlusion until stricture resolution. Inside stents might prevent duodenobiliary reflux and thus have longer stent patency, obviating the need for multiple ERCPs. Newly developed covered self-expandable metallic stents with anti-migration systems are alternatives to the placement of multiple plastic stents. With the advent of deep enteroscopy, biliary strictures in LDLT patients with Rouxen-Y hepaticojejunostomy are now treatable endoscopically. In this review, we discuss the short-and long-term outcomes of endoscopic management of post-LDLT strictures as well as recent advances in this field.

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“…5 It is reported in many studies that LDLT is a major risk factor for biliary complications. 6 Therefore, graft and operative risk factors should be evaluated separately for DDLT and LDLT. Small duct size and the possibility of multiple duct orifices increase the risk of biliary complications.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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Biliary complications are major sources of morbidity after liver transplant due to vulnerable vascularization of the bile ducts. Biliary complications are the "Achilles' heel" of liver transplant with their high incidence, need for repeated and prolonged treatment, and potential effects on graft and patient survival. Although standardization of reconstruction techniques and improvements in immunosuppression and organ preservation have reduced the incidence of biliary complications, in early reports the morbidity rates are 50%, with related mortality rate 25% to 30%. Prophylaxis is a major issue. Although many risk factors (old donor age, marginal graft, prolonged ischemia time, living-donor liver transplant, partial liver transplant, donation after cardiac death, hepatic arterial thrombosis, organ preservation, chronic rejection, and other donor and recipient characteristics) do not directly affect biliary complications, accumulation of the factors mentioned above, should be avoided. However, no accepted standard has been established. Treatment strategy is a subject of debate. Recently, nonoperative treatment of biliary complications have been preferred for diagnosis and therapy, because percutaneous or endoscopic treatment may prevent the need for surgical intervention. In this study, we reviewed our treatment of early and late biliary complications after liver transplant.

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Prolonged Cold Ischemic Time Is a Risk Factor for Biliary Strictures in Duct-to-Duct Biliary Reconstruction in Living Donor Liver Transplantation

Abstract: In this study, prolonged CIT is identified as a risk factor for BS in DD biliary reconstruction in LDLT.

Cited by 76 publications

References 22 publications

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Endoscopic management of biliary strictures after living donor liver transplantation

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