Prompt colonization of the hepaticojejunostomy and translocation of bacteria to liver after bile duct reconstruction

Chuang, Jiin‐Haur; Chen, Wei-Jen; Lee, Shin-Yi; Chang, Nyuk-Kong

doi:10.1016/s0022-3468(98)90153-1

Cited by 25 publications

(20 citation statements)

References 12 publications

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“…Most likely, this type of biliary reconstruction leads to reflux of bacteria into the biliary tree, as has been shown in animal models. 11 In a patient who is immunosuppressed and who has diminished flow of bile due to NAS, it is likely that this situation will lead to bacterial colonization of the bile ducts and repeated episodes of cholangitis.…”

Section: Discussionmentioning

confidence: 99%

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Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression

et al. 2007

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Nonanastomotic biliary strictures (NAS) after orthotopic liver transplantation (OLT) are associated with high retransplant rates. The aim of the present study was to describe the treatment of and identify risk factors for radiological progression of bile duct abnormalities, recurrent cholangitis, biliary cirrhosis, and retransplantation in patients with NAS. We retrospectively studied 81 cases of NAS. Strictures were classified according to severity and location. Management of strictures was recorded. Possible prognostic factors for bacterial cholangitis, radiological progression of strictures, development of severe fibrosis/cirrhosis, graft survival, and patient survival were evaluated. Median follow-up after OLT was 7.9 years. NAS were most prevalent in the extrahepatic bile duct. Twenty-eight patients (35%) underwent some kind of interventional treatment, leading to a marked improvement in biochemistry. Progression of disease was noted in 68% of cases with radiological follow-up. Radiological progression was more prevalent in patients with early NAS and one or more episodes of bacterial cholangitis. Recurrent bacterial cholangitis (Ͼ3 episodes) was more prevalent in patients with a hepaticojejunostomy. Severe fibrosis or cirrhosis developed in 23 cases, especially in cases with biliary abnormalities in the periphery of the liver. Graft survival, but not patient survival, was influenced by the presence of NAS. Thirteen patients (16%) were retransplanted for NAS. In conclusion, especially patients with a hepaticojejunostomy, those with an early diagnosis of NAS, and those with NAS presenting at the level of the peripheral branches of the biliary tree, are at risk for progressive disease with severe outcome. Liver Transpl 13: [725][726][727][728][729][730][731][732] 2007. © 2007 AASLD.Received September 19, 2006; accepted February 15, 2007. Biliary complications are common after orthotopic liver transplantation (OLT). Biliary strictures and leakage of bile are most frequently encountered. Strictures are often referred to as anastomotic or nonanastomotic. Nonanastomotic biliary strictures (NAS) are generally considered to be the most troublesome type of biliary complications after liver transplantation, with a graft loss rate of up to 46% after 2 years. 1In a separate study, we have analyzed the radiological characteristics of NAS at the time of diagnosis and risk factors for the development of NAS.2 In this study, we were able to identify statistically significant differences in risk factors for the development of NAS depending on the time of initial presentation. In addition, large variations in anatomical localization and severity of NAS at the time of presentation were found, indicating that NAS is not a single disease but rather a group of biliary abnormalities with different pathogenesis. It is unAbbreviations: NAS, nonanastomotic biliary strictures; OLT, orthotopic liver transplantation; PTCD, percutaneous transhepatic cholangiodrainage; ERCP, endoscopic retrograde cholangiopancreaticography; RR, relati...

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Section: Discussionmentioning

confidence: 99%

“…Nineteen had to be admitted repeatedly for recurrent bacterial cholangitis (defined as 3 or more episodes). The median number of cholangitis episodes in these 19 was 5 (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Thirty patients were placed on maintenance antibiotic therapy, mostly ciprofloxacin, for some time.…”

Section: Cholangitis Episodesmentioning

confidence: 99%

Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression

et al. 2007

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“…The intestinal loop of the anastomosis presumably contributes to an increased chance of intra-abdominal abscess formation, bacteremia, and sepsis. Regional sepsis and poor postoperative infection control can result in recurrent biliary leaks [24,25]. In the clinical scenario of a Roux-en-Y choledochojejunostomy without a transanastomotic catheter in place, a bile leak can be diagnosed with hepatobiliary scintigraphy and in selected patients with PTC [26,27].…”

Section: Specific Complicationsmentioning

confidence: 99%

Biliary complications after liver transplantation

Kalloo

2002

Curr Treat Options Gastro

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The incidence of biliary complications after liver transplant is estimated to be 8% to 20%. Post-liver transplant biliary complications may lead to acute and chronic liver injury. The early recognition and prompt treatment of such complications improves the long-term survival of the patient and graft. An understanding of the type of biliary reconstruction, the rationale for creating a particular anastomosis, and the technical difficulties in reconstructing the biliary tract are important in assessing and managing complications after liver transplant. Because the clinical presentation of these patients may be subtle, the physician must be aggressive and thoughtful in ordering and interpreting the diagnostic tests. Important points to remember are 1) that noninvasive examinations may fail to detect small obstructions or leaks, 2) a liver biopsy often is performed prior to cholangiography to exclude rejection and ischemia, and 3) the liver biopsy can miss an extrahepatic obstruction by misinterpreting portal inflammation as rejection. Biliary leaks and strictures are the most common biliary complications following liver transplant. Less common complications include ampullary dysfunction and stone/sludge formation. The effective management of biliary complications following a liver transplant depends on understanding the natural history, the prognosis, and the available therapeutic options for each type of complication.

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“…Chuang et al 29 showed that prompt colonization of the portoenterostomy may be one of the key factors responsible for early development of postoperative cholangitis, whereas Hirsig et al 30, 31 used their experimental studies in mini pigs to show that lymphatic obstruction was involved. As a result, we find the term ascending often used in conjunction with cholangitis (ie, ascending cholangitis) to be inappropriate and recommend that it not be used.…”

Section: Discussionmentioning

confidence: 99%

The intussusception antireflux valve is ineffective for preventing cholangitis in biliary atresia: a prospective study

Ogasawara¹,

Yamataka²,

Tsukamoto³

et al. 2003

Journal of Pediatric Surgery

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Prompt colonization of the hepaticojejunostomy and translocation of bacteria to liver after bile duct reconstruction

Cited by 25 publications

References 12 publications

Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression

Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression

Biliary complications after liver transplantation

The intussusception antireflux valve is ineffective for preventing cholangitis in biliary atresia: a prospective study

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