Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression
Open Access
- 24 April 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Liver Transplantation
- Vol. 13 (5), 725-732
- https://doi.org/10.1002/lt.21165
Abstract
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 (>3 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 13:725–732, 2007. © 2007 AASLD.Keywords
This publication has 11 references indexed in Scilit:
- Nonanastomotic biliary strictures after liver transplantation, part 1: Radiological features and risk factors for early vs. Late presentationLiver Transplantation, 2007
- CC chemokine receptor 5Δ32 polymorphism-a risk factor for ischemic-type biliary lesions following orthotopic liver transplantationLiver Transplantation, 2004
- Long-term follow-up of percutaneous transhepatic balloon cholangioplasty in the management of biliary strictures after liver transplantationTransplantation, 2004
- Risk Factors for and Clinical Course of Non‐Anastomotic Biliary Strictures After Liver TransplantationAmerican Journal of Transplantation, 2003
- Reconstructive Surgery for Ischemic-Type Lesions at the Bile Duct Bifurcation After Liver TransplantationAnnals of Surgery, 1999
- INCIDENCE AND MANAGEMENT OF BILIARY COMPLICATIONS AFTER 291 LIVER TRANSPLANTS FOLLOWING THE INTRODUCTION OF TRANSCYSTIC STENTINGTransplantation, 1998
- Transhepatic Balloon Dilation of Biliary Strictures in Liver Transplant Patients: A 10-year ExperienceJournal of Vascular and Interventional Radiology, 1995
- Biliary Tract Strictures after Orthotopic Liver Transplantation: Diagnosis and ManagementEndoscopy, 1994
- Intrahepatic biliary strictures after liver transplantation.Radiology, 1994
- Diagnostic features and clinical outcome of ischemic-type biliary complications after liver transplantationHepatology, 1993