Risk Factors for Biliary Complications After Orthotopic Liver Transplantation With T-Tube: A Single-Center Cohort of 743 Transplants

Gastaca, Mikel; Matarranz, A.; Martínez, L Álvarez; Valdivieso, A.; Ruíz, P.; Ventoso, A.; Fernández, José R.; Palomares, I.; Prieto, Mikel; Suárez, María; Urbina, J. Ortiz de

doi:10.1016/j.transproceed.2014.09.173

Cited by 10 publications

(6 citation statements)

References 9 publications

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“…3,4 Perioperative variables, including hemodynamic variations and transfusion volume, have been associated with these complications. [5][6][7][8][9][10][11] Nevertheless, very few interventions are known to decrease their incidence. 12,13 A recent clinical trial conducted in adult patients undergoing major abdominal surgery showed that a fixed restrictive fluid management strategy was associated with an increased risk of acute kidney injury (AKI).…”

Section: Résumémentioning

confidence: 99%

“…For the study by Feng et al, blood loss was study's primary outcome and ROB was assessed as "with some concerns" for the "measurement of the outcome" domain. 2 ROB assessed for need for NaHCO3 3 ROB assessed for pulmonary complications 4 ROB assessed for reintubation rate 5 ROB assessed for postoperative fluid balance (the ''before'' group), without increased need for RRT. 40 One before-after study reported similar creatinine levels at postoperative day 1, but lower levels in the restrictive group (the ''after'' group) on postoperative day 3.…”

Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

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Restrictive fluid management strategies and outcomes in liver transplantation: a systematic review

Carrier

Chassé

Wang

et al. 2019

Can J Anesth/J Can Anesth

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Purpose Restrictive fluid management strategies have been proposed to reduce complications in liver transplant recipients. We conducted a systematic review to evaluate the effects of restrictive perioperative fluid management strategies, compared with liberal ones, on postoperative outcomes in adult liver transplant recipients. Our primary outcome was acute kidney injury (AKI). Our secondary outcomes were bleeding, mortality, and other postoperative complications. Source We searched major databases (CINAHL, EMB Reviews, EMBASE, MEDLINE, and the grey literature) from their inception to 10 July 2018 for randomizedcontrolled trials (RCTs) and observational studies comparing two fluid management strategies (or observational studies reporting two outcomes with available data on fluid volume received) in adult liver transplant recipients. Study selection, data abstraction, and risk of bias assessment were performed by at least two investigators. Data from RCTs were pooled using risk ratios (RR) and mean differences (MD) with random-effect models. Principal findings We found seven RCTs and 29 observational studies. Based on RCTs, fluid management Electronic supplementary material The online version of this article (

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Section: Résumémentioning

confidence: 99%

Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

Restrictive fluid management strategies and outcomes in liver transplantation: a systematic review

Carrier

Chassé

Wang

et al. 2019

Can J Anesth/J Can Anesth

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“…It is possible that there are different factors involved in the genesis of these events after liver transplantation; however, the results found in the literature are varied and contradictory. Building on the large number of potential factors that have been associated with biliary complications and the variety of results obtained, we offer a large cohort of patients which received organs of young donors to contribute to clarify this challenging subject 6,9 .…”

Section: Discussionmentioning

confidence: 99%

“…CMV infection and its relationship with a higher occurrence of biliary complications have been the subject of discussion 3,7,9,10 . In this sense, the high percentage of individuals serologically positive for CMV in Brazil stands out -a prevalence of 80 to 100% -compared to a prevalence of 40 to 60% in developed countries 21,26,31 .…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Post-Liver Transplant Biliary Complications in the Absence of Arterial Complications

Lima

Pereira

Jungmann³

et al. 2020

ABCD, arq. bras. cir. dig.

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Background - Biliary complications (BC) represent the most frequent complication after liver transplantation, up to 34% of cases. Aim: To identify modifiable risk factors to biliary complications after liver transplantation, essential to decrease morbidity. Method: Clinical data, anatomical characteristics of recipient and donors, and transplant operation features of 306 transplants with full arterial patency were collected to identify risk factors associated with BC. Results: BC occurred in 22.9% after 126 days (median) post-transplantation. In univariate analyses group 1 (without BC, n=236) and group 2 patients (with BC, n=70) did not differ on their general characteristics. BC were related to recipient age under 40y (p=0.029), CMV infection (p=0.021), biliary disease as transplant indication (p=0.018), lower pre-transplant INR (p=0.009), and bile duct diameter <3 mm (p=0.033). CMV infections occurred sooner in patients with postoperative biliary complications vs. control (p=0.07). In a multivariate analysis, only CMV infection, lower INR, and shorter bile duct diameter correlated with BC. Positive CMV antigenemia correlated with biliary complications, even when titers lied below the treatment threshold. Conclusions: Biliary complications after liver transplantation correlated with low recipient INR before operation, bile duct diameter <3 mm, and positive antigenemia for CMV or disease manifestation. As the only modifiable risk factor, routine preemptive CMV inhibition is suggested to diminish biliary morbidity after liver transplant.

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“…However, our findings of increased intraoperative blood loss in patients developing biliary complications ( P < 0.001) has been reported in a few other studies. 25,26 A recent study on a large cohort of liver transplanted children did not see a correlation between intraoperative blood units transfused and the development of biliary complications, 27 suggesting adults might be more sensitive to intraoperative blood loss and development of such complications.…”

Section: Discussionmentioning

confidence: 99%

Long-term Outcome of Endoscopic and Percutaneous Transhepatic Approaches for Biliary Complications in Liver Transplant Recipients

Rönning

Berglund

Arnelo

et al. 2019

Transplantation Direct

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BackgroundBiliary complications occur in 6% to 34% of liver transplant recipients, for which endoscopic retrograde cholangiopancreatography has become widely accepted as the first-line therapy. We evaluated long-term outcome of biliary complications in patients liver transplanted between 2004 and 2014 at Karolinska University Hospital, Stockholm.MethodsData were retrospectively collected, radiological images were analyzed for type of biliary complication, and graft and patient survivals were calculated.ResultsIn 110 (18.5%) of 596 transplantations, there were a total of 153 cases of biliary complications: 68 (44.4%) anastomotic strictures, 43 (28.1%) nonanastomotic strictures, 24 (15.7%) bile leaks, 11 (7.2%) cases of stone- and/or sludge-related problems, and 7 (4.6%) cases of mixed biliary complications. Treatment success rates for each complication were 90%, 73%, 100%, 82% and 80%, respectively. When the endoscopic approach was unsatisfactory or failed, percutaneous transhepatic cholangiography or a combination of treatments was often successful (in 18 of 24 cases). No procedure-related mortality was observed. Procedure-related complications were reported in 7.7% of endoscopic retrograde cholangiopancreatography and 3.8% of percutaneous transhepatic cholangiography procedures. Patient survival rates, 1, 3, 5, and 10 years posttransplant in patients with biliary complications were 92.7%, 80%, 74.7%, and 54.1%, respectively, compared with 92%, 86.6%, 83.7%, and 72.8% in patients free from biliary complications (P < 0.01). Similarly, long-term graft survival was lower in the group experiencing biliary complications (P < 0.0001).ConclusionsEndoscopic and percutaneous approaches for treating biliary complications are safe and efficient and should be considered complementing techniques. Despite a high treatment success rate of biliary complications, their occurrence still has a significant negative impact on patient and graft long-term survivals.

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Risk Factors for Biliary Complications After Orthotopic Liver Transplantation With T-Tube: A Single-Center Cohort of 743 Transplants

Cited by 10 publications

References 9 publications

Restrictive fluid management strategies and outcomes in liver transplantation: a systematic review

Restrictive fluid management strategies and outcomes in liver transplantation: a systematic review

Risk Factors for Post-Liver Transplant Biliary Complications in the Absence of Arterial Complications

Long-term Outcome of Endoscopic and Percutaneous Transhepatic Approaches for Biliary Complications in Liver Transplant Recipients

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