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Hong SK, Akamatsu N, Ito T, Yoon YI, Rhu J, Toshima T, Shimata K, Lee JG, Lee KW, Ikegami T, Lee SG, Choi Y, Yi NJ, Suh KS. Short-term and long-term outcomes of donor and recipient in living donor liver transplantation using variant grafts. Liver Transpl 2023; 29:900-905. [PMID: 36866866 DOI: 10.1097/lvt.0000000000000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/16/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nobuhisa Akamatsu
- Department of Surgery, Artificial Organ and Transplantation Division, The University of Tokyo, Tokyo, Japan
| | - Takashi Ito
- Department of Hepatobiliary, Pancreas, and Transplant Surgery, Kyoto University, Kyoto, Japan
| | - Young-In Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Takeo Toshima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Toru Ikegami
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Cui SP, Lyu SC, Wang J, Chen Q, Huang JC, Wang HX, He Q, Lang R. Application of cholecystic duct plasty in the prevention of biliary complications following orthotopic liver transplantation. Front Surg 2023; 10:1087327. [PMID: 37206346 PMCID: PMC10189116 DOI: 10.3389/fsurg.2023.1087327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
Background The purpose was aimed to evaluate the safety and effectiveness of cholecystic duct plasty (CDP) and biliary reconstruction techniques preventing biliary complications following orthotopic liver transplantation (OLT) first proposed by our center. Methods 127 enrolled patients who underwent LT in our center from January 2015 to December 2019 were analyzed retrospectively. According to the mode of biliary tract reconstruction, patients were divided into CDP group (Group 1, n = 53) and control group (Group 2, n = 74). The differences of perioperative general data, biliary complications and long-term prognosis between two groups were compared and analyzed. Results All patients completed the operation successfully, the incidence of perioperative complications was 22.8%. There was no significant difference in perioperative general data and complications between the two groups. Follow-up ended in June 2020, with a median follow-up period of 31 months. During the follow-up period, biliary complications occurred in 26 patients, with an overall incidence of 20.5%. The overall incidence of biliary complications and anastomotic stenosis in Group 1 was lower than that in Group 2 (P < 0.05). There was no significant difference in overall prognosis between the two groups (P = 0.274), however, the cumulative incidence of biliary complications in Group 1 was lower than that in Group 2 (P = 0.035). Conclusion Reconstruction of common bile duct by CDP represents considerable safety and practicability, particularly for patients with small diameter of common bile duct or wide discrepancy of bile duct size between donor and recipient.
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Affiliation(s)
- Song-ping Cui
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Shao-cheng Lyu
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Thoracic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Qing Chen
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Jin-can Huang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Han-xuan Wang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Qiang He
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Ren Lang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
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Seckler F, Turco C, Mohkam K, Addeo P, Robin F, Cauchy F, Maulat C, Brustia R, Paquette B, Faitot F, Weil Verhoeven D, Minello A, Lakkis Z, Di Martino V, Latournerie M, Chiche L, El Amrani M, Bucur P, Navarro F, Chopinet S, Chirica M, Gagnière J, Iannelli A, Cheisson G, Chardot C, Sommacale D, Muscari F, Dondero F, Sulpice L, Bachellier P, Scatton O, Mabrut JY, Heyd B, Doussot A. Liver Transplantation Using Allografts With Recent Liver Blunt Trauma: A Nationwide Audit From the French CRISTAL Biomedicine Agency Registry. Transplantation 2023; 107:664-669. [PMID: 36477606 DOI: 10.1097/tp.0000000000004434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the current setting of organ shortage, brain-dead liver donors with recent liver trauma (RLT) represent a potential pool of donors. Yet, data on feasibility and safety of liver transplantation (LT) using grafts with RLT are lacking. METHODS All liver grafts from brain-dead donors with RLT proposed for LT between 2010 and 2018 were identified from the nationwide CRISTAL registry of the Biomedicine Agency. The current study aimed at evaluating 1-y survival as the primary endpoint. RESULTS Among 11 073 LTs, 142 LTs (1.3%) using grafts with RLT were performed. These 142 LTs, including 23 split LTs, were performed from 131 donors (46.1%) of 284 donors with RLT proposed for LT. Transplanted grafts were procured from donors with lower liver enzymes levels ( P < 0.001) and less advanced liver trauma according to the American Association for the Surgery of Trauma liver grading system ( P < 0.001) compared with not transplanted grafts. Before allocation procedures, 20 (7%) of 284 donors underwent damage control intervention. During transplantation, specific liver trauma management was needed in 19 patients (13%), consisting of local hemostatic control (n = 15), partial hepatic resection on back-table (n = 3), or perihepatic packing (n = 1). Ninety-day mortality and severe morbidity rates were 8.5% (n = 12) and 29.5% (n = 42), respectively. One-year overall and graft survival rates were 85% and 81%, and corresponding 5-y rates were 77% and 72%, respectively. CONCLUSIONS Using liver grafts from donors with RLT seems safe with acceptable long-term outcomes. All brain-dead patients with multiorgan trauma, including liver injury, should be considered for organ allocation.
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Affiliation(s)
- Florian Seckler
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - Célia Turco
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Kayvan Mohkam
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pietro Addeo
- Department of Digestive Surgery, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Fabien Robin
- Department of Hepatobiliary and Digestive Surgery, Hôpital Pontchaillou, CHU, Rennes, France
| | - François Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Charlotte Maulat
- Department of Visceral Surgery, Hôpital Rangueil, CHU Toulouse, Toulouse, France
| | - Raffaele Brustia
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri-Mondor, Créteil, France
| | - Brice Paquette
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - François Faitot
- Department of Digestive Surgery, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Anne Minello
- Department of Hepatology, CHU Dijon, Dijon, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | | | | | - Laurence Chiche
- Department of Digestive Surgery, CHU Bordeaux, Pessac, France
| | - Mehdi El Amrani
- Department of Digestive Surgery and Transplantation, Hôpital Huriez, CHU Lille, Lille, France
| | - Petru Bucur
- Department of Digestive Surgery, Hepatobiliary Surgery and Liver Transplantation, CHU Tours, Tours, France
| | - Francis Navarro
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France
| | - Sophie Chopinet
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital la Timone, Assistance Publique-Hôpitaux de Marseille, France
| | - Mircea Chirica
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, CHU Grenoble Alpes, France
| | - Johan Gagnière
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, CHU Estaing, Clermont-Ferrand, France
| | - Antonio Iannelli
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Archet 2, CHU Nice, France
| | - Gaëlle Cheisson
- Department of Anesthesia and Intensive Care, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Christophe Chardot
- Department of Pediatric Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Daniele Sommacale
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri-Mondor, Créteil, France
| | - Fabrice Muscari
- Department of Visceral Surgery, Hôpital Rangueil, CHU Toulouse, Toulouse, France
| | - Federica Dondero
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive Surgery, Hôpital Pontchaillou, CHU, Rennes, France
| | - Philippe Bachellier
- Department of Digestive Surgery, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Olivier Scatton
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Jean Yves Mabrut
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Bruno Heyd
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
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Horwitz JK, Kaldas FM. CAQ Corner: Technical considerations in liver transplantation (101 for hepatologists). Liver Transpl 2023; 29:217-225. [PMID: 36055761 DOI: 10.1002/lt.26556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/30/2022] [Accepted: 06/21/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Julian K Horwitz
- Division of Liver and Pancreas Transplantation, Department of Surgery , David Geffen School of Medicine at the University of California Los Angeles , Los Angeles , California , USA
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Trivedi P, Saben JL, Liu L, Malamon JS, Pomfret E, Pshak T. Preliminary safety and efficacy of laser stricturotomy for treatment of refractory biliary anastomotic strictures following liver transplantation. Am J Transplant 2023; 23:573-576. [PMID: 36695697 DOI: 10.1016/j.ajt.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/15/2022] [Accepted: 12/07/2022] [Indexed: 01/05/2023]
Abstract
Biliary anastomotic stricture (BAS) is a frequent complication of liver transplantation and is associated with reduced graft survival and patient morbidity. Existing treatments for BAS involve dilation of the stricture though placement of 1 or more catheters for 6 to 24 months yielding limited effectiveness in transplant patients. In this case series, we present preliminary safety and efficacy of a novel percutaneous laser stricturotomy treatment in a cohort of 5 posttransplant patients with BAS refractory to long-term large bore catheterization. In all patients, holmium or thulium laser was used to excise the stricture and promote biliary re-epithelization. There were no periprocedural complications. Technical success was 100% and at mean follow-up time of 22 months, there have been no recurrences. In conclusion, percutaneous laser stricturotomy demonstrates preliminary safety and efficacy in treatment of refractory BAS following liver transplantation.
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Affiliation(s)
- Premal Trivedi
- Department of Radiology-Interventional, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Jessica L Saben
- Department of Surgery-Transplant Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education, Aurora, Colorado, USA
| | - Lisa Liu
- Department of Radiology-Interventional, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John S Malamon
- Department of Surgery-Transplant Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education, Aurora, Colorado, USA
| | - Elizabeth Pomfret
- Department of Surgery-Transplant Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education, Aurora, Colorado, USA
| | - Thomas Pshak
- Department of Surgery-Transplant Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
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Dabbous H, Elsayed A, Salah M, Montasser I, Atef M, Elmetenini M. Risk factors and management of biliary stones after living donor liver transplant and its effect on graft outcome. Front Med (Lausanne) 2022; 9:927744. [PMID: 36082268 PMCID: PMC9445190 DOI: 10.3389/fmed.2022.927744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background Bile stones are associated with numerous complications in liver transplant recipients. Endoscopic retrograde cholangiopancreatography (ERCP) has been proven to be safe and highly effective in dealing with most post-transplant biliary complications. Objective The objective of this study was to identify the possible risk factors for bile stone formation on top of biliary stricture, the effects of stones on graft outcomes, and their management. Methods This case–control study included 83 patients who underwent living donor liver transplant (LDLT) and suffered from postoperative biliary stricture with or without stones. Patients were divided into two groups. Group 1 (n = 55) included patients with biliary strictures with no stones and group 2 (n = 28) included patients who developed stones on top of biliary strictures. Data about the recipient and donor characteristics, surgical technique, blood lipid profile, immunosuppressive drugs, post-transplant complications, and interventions were collected from the medical records. Results The frequency of hepatitis C virus (HCV) was significantly higher in group 2 compared to group 1 (71.4% vs. 47.3%, p = 0.036). The body mass index (BMI) of the donors was significantly higher in group 2 than in group 1 (25.17 ± 2.53 vs. 23.68 ± 2.63, p = 0.015). Episodes of acute rejection were significantly higher in group 2 than in group 1 (21.4% vs. 5.5%, p = 0.027). The ERCP was sufficient in most of the cases (89.2%) to ensure biliary drainage. The identified independent risk factors for biliary stones included HCV, biliary drain, donor's BMI, and serum cholesterol level. Conclusion Positive HCV, biliary drain insertion, donor's BMI, and serum cholesterol level were independent risk factors for developing bile stones on top of biliary strictures. Biliary stones were associated with high episodes of acute graft rejection, and they could be successfully managed by the ERCP modality.
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Affiliation(s)
- Hany Dabbous
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation, Ain Shams University, Cairo, Egypt
- *Correspondence: Hany Dabbous
| | - Ashraf Elsayed
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation, Ain Shams University, Cairo, Egypt
| | - Manar Salah
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation, Ain Shams University, Cairo, Egypt
| | - Iman Montasser
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation, Ain Shams University, Cairo, Egypt
| | - Mohamed Atef
- Tropical Medicine Department, Ain Shams University, Cairo, Egypt
| | - Mahmoud Elmetenini
- Hepatobiliary Surgical Department, Ain Shams Center for Organ Transplantation, Ain Shams University, Cairo, Egypt
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The use of the T-tube in biliary tract reconstruction during orthotopic liver transplantation: An umbrella review. Transplant Rev (Orlando) 2022; 36:100711. [PMID: 35843181 DOI: 10.1016/j.trre.2022.100711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022]
Abstract
Biliary complications are one of the main concerns after liver transplantation, and to avoid these, the use of a T-tube has been advocated in biliary reconstruction. Most liver transplantation centres perform a biliary anastomosis without a T-tube to avoid the risk of complications and T-tube-related costs. Several meta-analyses have reached discordant conclusions regarding the benefits of using the T-tube. An umbrella review was performed to summarise quantitative measures about overall biliary complications, biliary leaks, biliary strictures and cholangitis associated with the T-tube use after liver transplantation. Published systematic reviews and meta-analyses related to the use of T-Tube in liver transplantation were searched and analysed. From the comprehensive literature search from PubMed, EMBASE and Cochrane Library databases on the 25th of October 2021, 104 records were retrieved. Seven meta-analyses and two systematic reviews were included in the final analysis. All the meta-analyses of RCT stated no differences in overall biliary complications and biliary leaks when using T-tube for a liver transplant (I2 ≥ 90% and I2 range 0-76%, respectively). The meta-analysis of the RCTs evaluating the risks of biliary strictures after liver transplantation showed that T-tube protects from the complication (I2 range 0-80%). Biliary anastomosis without a T-tube has equivalent overall biliary complications and bile leaks compared to the T-tube reconstruction. The incidence of biliary strictures is attenuated in patients with T-tubes, and most meta-analyses of RCTs have very low heterogeneity. Therefore, the present umbrella review suggests a selective T-tube use, particularly in small biliary ducts or transplants with marginal grafts at high risk of post-LT strictures.
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8
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Long-term Clinical Outcomes and Predictive Factors for Living-donor Liver Transplant Recipients With Biliary Strictures. Transplantation 2022; 106:1990-1999. [PMID: 35771085 DOI: 10.1097/tp.0000000000004201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Biliary strictures frequently occur in living-donor liver transplant (LDLT) recipients. However, long-term clinical outcomes and their associated factors are unclear. METHODS We analyzed an historical cohort of 228 recipients who underwent LDLT with post-liver transplantation biliary strictures. Endoscopic retrograde cholangiography or percutaneous transhepatic biliary drainage were performed to treat biliary strictures. Patients that experienced persistent jaundice over 3 mo after the initial treatment were defined as a remission-failure group. RESULTS Median observation period was 8.5 y after the diagnosis of biliary stricture. The 15-y graft survival (GS) rate was 70.6%, and 15-y rate of developing portal hypertension (PH) was 26.1%. Remission failure occurred in 25.0% of study participants. In the multivariate analysis, biopsy-proven acute rejection, and portal vein/hepatic artery abnormalities were risk factors for remission failure. Development of PH, retransplantation, and death were significantly more frequent in the remission-failure group. Remission failure and PH were associated with poor GS. In multivariate analyses, hepatic artery abnormality and biloma were common significant factors that were associated with a poor GS and development of PH. CONCLUSIONS The insufficient blood supply reflected by hepatic artery abnormality and biloma might be the most important factor that can predict poor long-term survival in LDLT patients with biliary strictures. Future large-scale prospective studies are needed to validate our observations.
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Georges P, Clerc C, Turco C, Di Martino V, Paquette B, Minello A, Calame P, Magnin J, Vuitton L, Weil-Verhoeven D, Lakkis Z, Vanlemmens C, Latournerie M, Heyd B, Doussot A. Post-Transplantation Cytomegalovirus Infection Interplays With the Development of Anastomotic Biliary Strictures After Liver Transplantation. Transpl Int 2022; 35:10292. [PMID: 35721468 PMCID: PMC9200969 DOI: 10.3389/ti.2022.10292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/27/2022] [Indexed: 12/29/2022]
Abstract
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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Affiliation(s)
- Pauline Georges
- Department of Digestive Surgical Oncology –Liver Transplantation Unit, University Hospital of Besançon, Besancon, France
| | - Clémentine Clerc
- Department of Hepatology, University Hospital of Dijon, Dijon, France
| | - Célia Turco
- Department of Digestive Surgical Oncology –Liver Transplantation Unit, University Hospital of Besançon, Besancon, France
| | - Vincent Di Martino
- Department of Hepatology, University Hospital of Besançon, Besancon, France
| | - Brice Paquette
- Department of Digestive Surgical Oncology –Liver Transplantation Unit, University Hospital of Besançon, Besancon, France
| | - Anne Minello
- Department of Hepatology, University Hospital of Dijon, Dijon, France
| | - Paul Calame
- Department of Radiology, University Hospital of Besançon, Besancon, France
| | - Joséphine Magnin
- Department of Digestive Surgical Oncology –Liver Transplantation Unit, University Hospital of Besançon, Besancon, France
| | - Lucine Vuitton
- Department of Gastroenterology, University Hospital of Besançon, Besancon, France
| | | | - Zaher Lakkis
- Department of Digestive Surgical Oncology –Liver Transplantation Unit, University Hospital of Besançon, Besancon, France
| | - Claire Vanlemmens
- Department of Hepatology, University Hospital of Besançon, Besancon, France
| | | | - Bruno Heyd
- Department of Digestive Surgical Oncology –Liver Transplantation Unit, University Hospital of Besançon, Besancon, France
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology –Liver Transplantation Unit, University Hospital of Besançon, Besancon, France
- *Correspondence: Alexandre Doussot,
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Vest M, Ciobanu C, Nyabera A, Williams J, Marck M, Landry I, Sumbly V, Iqbal S, Shah D, Nassar M, Nso N, Rizzo V. Biliary Anastomosis Using T-tube Versus No T-tube for Liver Transplantation in Adults: A Review of Literature. Cureus 2022; 14:e24253. [PMID: 35602800 PMCID: PMC9117859 DOI: 10.7759/cureus.24253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/06/2022] Open
Abstract
The T-tube-directed biliary anastomosis in orthotopic liver transplantation (OLT) aims to minimize preventable biliary complications, including bile leaks and strictures. Biliary complications in patients with OLT increase the risk of morbidity and mortality. This review paper evaluated the current evidence on the routine use of T-tube reconstruction in OLT cases. A review of prospective, retrospective, observational, cohort studies as well as systematic reviews, meta-analyses, review papers, and opinion papers has been conducted to evaluate the therapeutic potential of T tube-based biliary anastomosis in cases of OLT. Our finding showed a bile leak incidence of 16.6% and 6.6% in T-tube and non-T-tube groups, respectively. The results indicated a lower incidence of anastomotic fistulae in the non-T-tube group (0.6%) compared to the T-tube group (4%). The findings negated statistically significant differences in the three-year actuarial survival rates based on biliary anastomosis with and without T-tube intervention (62.5% vs. 69.8%). The studies revealed a 6-11% and 2-11% incidence of cholangitis in OLT patients with T-tube-based reconstruction and those without a T-tube, respectively, and 26% and 20% incidence of total biliary complications in OLT patients with and without T-tube, respectively. In addition, the findings ruled out the influence of a T-tube on the incidence of perioperative complications, endoscopies, and reoperations in OLT cases. The current evidence correlates the increased incidence of bile leaks, cholangitis, and overall biliary complications with the use of a T-tube during OLT. In addition, T-tube-guided reconstruction has no impact on perioperative complications, overall survival, endoscopies, and reoperations in OLT cases.
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11
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Outcomes in Adult Liver Transplant Recipients Using Pediatric Deceased Donor Liver Grafts. Transplant Direct 2022; 8:e1315. [PMID: 35415214 PMCID: PMC8989770 DOI: 10.1097/txd.0000000000001315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/04/2022] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
Background. The use of pediatric grafts for liver transplantation (LT) into adult recipients is rare, and reported outcomes are conflicting. The aim of this study is to evaluate the outcomes in adult recipients following LT with grafts from deceased pediatric donors. Methods. A retrospective study identifying adult LT between 2010 and 2020 using pediatric deceased donor liver grafts was conducted. Adults undergoing LT with deceased donor pediatric grafts (age ≤ 12) were identified and matched 1:2 with adults receiving adult grafts (age ≥ 18) based on recipient age (±10 y), model for end-stage liver disease (MELD) score at transplant (±5 points) and etiology of liver disease. To assess real liver size differences between the pediatric-donor and adult-donor groups, patients receiving a graft from a donor between 13 and 17 y were excluded from the main analysis and studied independently. Outcomes between the groups were compared. Complication rates were identified and graded using Clavien–Dindo classification. Graft and patient survival were assessed by Kaplan–Meier curves. Results. Twelve adult LT recipients with whole liver grafts from deceased pediatric donors were matched with 24 adult recipients of adult donors. Recipient age and MELD score were similar between groups. Recipients of pediatric grafts were more likely to be female (66.7% versus 16.7%, P = 0.007) and leaner (body mass index = 24.4 versus 29.9, P = 0.013). Alcohol-related cirrhosis was the most prevalent liver disease etiology in both groups (P = 0.96). There was no significant difference in length of stay, readmissions, early complications, or major complications between groups. Vascular and biliary complication rates were similar. Actuarial graft and patient survival at 1, 3, and 5 y were 100/100/100 versus 96/96/96 (P = 0.48). Conclusions. Excellent patient and graft survival is achievable with LT using young pediatric deceased donor grafts in smaller adult recipients. Outcomes are comparable with recipients of age and MELD-matched adult donors. Careful donor MELD-score recipient matching and close monitoring for potential biliary and vascular complications are crucial to achieve acceptable outcomes.
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Guirguis RN, Nashaat EH, Yassin AE, Ibrahim WA, Saleh SA, Bahaa M, El-Meteini M, Fathy M, Dabbous HM, Montasser IF, Salah M, Mohamed GA. Biliary complications in recipients of living donor liver transplantation: A single-centre study. World J Hepatol 2021; 13:2081-2103. [PMID: 35070010 PMCID: PMC8727210 DOI: 10.4254/wjh.v13.i12.2081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Biliary complications (BCs) after liver transplantation (LT) remain a considerable cause of morbidity, mortality, increased cost, and graft loss.
AIM To investigate the impact of BCs on chronic graft rejection, graft failure and mortality.
METHODS From 2011 to 2016, 215 adult recipients underwent right-lobe living-donor liver transplantation (RT-LDLT) at our centre. We excluded 46 recipients who met the exclusion criteria, and 169 recipients were included in the final analysis. Donors’ and recipients’ demographic data, clinical data, operative details and postoperative course information were collected. We also reviewed the management and outcomes of BCs. Recipients were followed for at least 12 mo post-LT until December 2017 or graft or patient loss.
RESULTS The overall incidence rate of BCs including biliary leakage, biliary infection and biliary stricture was 57.4%. Twenty-seven (16%) patients experienced chronic graft rejection. Graft failure developed in 20 (11.8%) patients. A total of 28 (16.6%) deaths occurred during follow-up. BCs were a risk factor for the occurrence of chronic graft rejection and failure; however, mortality was determined by recurrent hepatitis C virus infection.
CONCLUSION Biliary complications after RT-LDLT represent an independent risk factor for chronic graft rejection and graft failure; nonetheless, effective management of these complications can improve patient and graft survival.
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Affiliation(s)
- Reginia Nabil Guirguis
- Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Ehab Hasan Nashaat
- Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Azza Emam Yassin
- Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Wesam Ahmed Ibrahim
- Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Shereen A Saleh
- Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Mohamed Bahaa
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Mahmoud El-Meteini
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Mohamed Fathy
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Hany Mansour Dabbous
- Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Iman Fawzy Montasser
- Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Manar Salah
- Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Ghada Abdelrahman Mohamed
- Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
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Song S, Lu T, Yang W, Gong S, Lei C, Yang J, Feng L, Tian H, Yang K, Guo T. T-tube or no T-tube for biliary tract reconstruction in orthotopic liver transplantation: an updated systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2021; 15:1201-1213. [PMID: 33720798 DOI: 10.1080/17474124.2021.1903874] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Biliary tract reconstruction with or without T-tube is commonly used in orthotopic liver transplantation (OLT). However, the efficacy and safety of T-tube usage remain controversial. This meta-analysis was conducted to assess the latest evidence of clinical outcomes.Methods: Embase, Cochrane Library, PubMed, and Web of Science were systematically searched from inception to 20 January 2021 for eligible studies. The analyses were performed using Review Manager and Stata.Results: A total of 24 trials involving 3320 participants were included in the meta-analysis. Compared with the no T-tube group, there was a higher incidence of overall biliary complications (OR:1.54; 95%CI, 1.06-2.24; P = 0.02), bile leaks (OR:2.34; 95%CI,1.57-3.48; P < 0.0001), cholangitis (OR:2.78; 95%CI,1.19-6.51; P = 0.002), and longer cold ischemia time (MD:22.27; 95%CI,0.80-43.74; P = 0.04) in the T-tube group. Furthermore, the no T-tube group had significantly higher odds of biliary strictures than the T-tube group (OR:0.60; 95%CI, 0.47-0.78; P = 0.0001).Conclusion: T-tube is still not routinely recommended, but is a good choice for OLT patients at high risk of biliary strictures. Notably, the higher rate of biliary complications in the T-tube group did not translate into an increase in endoscopic or re-operative interventions.
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Affiliation(s)
- Shaoming Song
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Tingting Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Wenwen Yang
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Shiyi Gong
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Caining Lei
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Jia Yang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Lufang Feng
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Hongwei Tian
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China
| | - Tiankang Guo
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
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14
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Park JW, Park HY, Park M, Yang M, Mun GH. Effects of antihypertensive drugs on surgical outcomes of breast reconstruction: a nationwide population-based claim study. Gland Surg 2021; 10:2130-2139. [PMID: 34422584 DOI: 10.21037/gs-21-220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/09/2021] [Indexed: 12/24/2022]
Abstract
Background Experimental studies have reported that angiotensin receptor blockers (ARBs) increase the risk of surgical complications. However, clinical data on their effect on surgical outcomes are limited. The aim of this study was to investigate the impact of perioperative use of ARBs on the outcomes of breast reconstruction using population-based claim data. Methods Data of patients who underwent direct-to-implant or abdomen-based autologous breast reconstruction after total mastectomy from April 2015 to December 2018 were obtained from the Health Insurance Review and Assessment Service database. The patients were categorized as ARB, non-ARB, control, and non-hypertension groups. The effects of ARBs on surgical complications, length of hospital stay, and complication-related medical costs were evaluated. Results Of the 9,036 patients who met the inclusion criteria, 5,192 underwent direct-to-implant reconstruction, and 3,844 underwent abdomen-based autologous reconstruction. The length of hospital stay was the longest and the surgical complication rate and complication-related medical cost were the highest in the ARB group after both reconstruction methods. Compared with non-treatment with antihypertensive drugs, ARB use was found to be an independent risk factor for surgical complications in direct-to-implant reconstruction [odds ratio (OR), 1.96; 95% confidence interval (CI), 1.09-3.50; P=0.0237] and complication-related medical cost (OR, 1.93; 95% CI, 1.10-3.40; P=0.0221) in abdomen-based autologous reconstruction. Conclusions Perioperative ARB use was associated with adverse postoperative breast reconstruction outcomes. These findings might have a significant impact on perioperative antihypertensive management; nevertheless, further studies are warranted to confirm the study findings.
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Affiliation(s)
- Jin-Woo Park
- Department of Plastic Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Korea
| | - Hae Yeon Park
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Korea
| | - Minsu Park
- Department of Statistics, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, Korea
| | - Mi Yang
- Seoul Mental Health Welfare Center, Dongsung 3-gil, Jongno-gu, Seoul, Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Korea
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15
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Gruttadauria S, Tropea A, Pagano D, Calamia S, Ricotta C, Bonsignore P, Li Petri S, Cintorino D, di Francesco F. Case report: Trans-papillary free stenting of the cystic duct and of the common bile duct in a double biliary ducts anastomoses of a right lobe living donor transplantation. BMC Surg 2021; 21:44. [PMID: 33468113 PMCID: PMC7816360 DOI: 10.1186/s12893-020-01045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background One of the major issues related to the living donor liver transplantation recipient outcome is still the high rate of biliary complication, especially when multiple biliary ducts are present and multiple anastomoses have to be performed. Case presentation and conclusion We report a case of adult-to-adult right lobe living donor liver transplantation performed for a recipient affected by alcohol-related cirrhosis with MELD score of 17. End-stage liver disease was complicated by refractory ascites, portal hypertension, small esophageal varices and portal gastropathy, hypersplenism, and abundant right pleural effusion. Here in the attached video we described the adult-to-adult LDLT procedures, where a right lobe with two biliary ducts draining respectively the right anterior and the right posterior segments has been transplanted. LDLT required a biliary reconstruction using the native cystic and common bile ducts stented trans-papillary with two 5- French 6 cm long soft silastic catheter. None major complications were detected during post-operative clinical courses. Actually, the donor and the recipient are alive and well. The technique we describe in the video, allow to keep the biliary anastomoses protected and patent without having the risk of creating cholestasis and the need of invasive additional procedure. No living donor right lobe transplantation should be refused because of the presence of multiple biliary ducts.
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Affiliation(s)
- Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy. .,Department of Surgery and Surgical and Medical Specialties, University of Catania, Catania, Italy.
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Duilio Pagano
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Sergio Calamia
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Calogero Ricotta
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Pasquale Bonsignore
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Sergio Li Petri
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Davide Cintorino
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Fabrizio di Francesco
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
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16
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Abstract
Liver transplantation has become a definitive treatment for patients with end-stage liver disease and those meeting Milan criteria for hepatocellular carcinoma. The morbidity and mortality associated with liver transplantation continues to decrease thanks to refinements in surgical technique, immunosuppression, and imaging. In particular, imaging plays a vital role by facilitating early detection of post-operative complications and enabling prompt treatment. Post-operative complications that lead to graft failure and patient morbidity/mortality can be generally categorized as vascular, biliary, parenchymal, and malignant. Vascular complications include stenosis and thrombosis of the hepatic artery, portal vein, and inferior vena cava; hepatic artery pseudoaneurysm; arteriovenous fistula; and celiac stenosis. Biliary abnormalities include strictures, bile leak, obstruction, recurrent disease, and infection. While imaging is not primarily utilized to diagnose allograft rejection, it plays an important role in excluding mechanical causes of graft dysfunction that can mimic rejection. Ultrasound is routinely performed as the first-line imaging evaluation for the detection and follow-up of early and delayed complications. Cholangiography and magnetic resonance cholangiopancreatography are useful in detecting and characterizing biliary complications. Computed tomography is often used to further evaluate abnormal findings on ultrasound or for the characterization of post-operative fluid collections. The aim of this review is to discuss and illustrate the imaging findings of complications associated with liver transplantation and their role in facilitating treatment.
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17
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Biliary Strictures Are Associated With Both Early and Late Hepatic Artery Stenosis. Transplant Direct 2020; 7:e643. [PMID: 33335982 PMCID: PMC7738047 DOI: 10.1097/txd.0000000000001092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/30/2020] [Indexed: 12/21/2022] Open
Abstract
Background. Hepatic artery stenosis (HAS) following liver transplantation results in hypoperfusion and ischemic damage to the biliary tree. This study aimed to investigate how vascular intervention, liver function test derangement, and time point of HAS onset influence biliary complications. Methods. A single-center retrospective study of adult patients that underwent primary liver transplantation. Patients were grouped according to the presence or absence of HAS and then into early (≤90 d) or late (>90 d) subgroups. Biliary complications comprised anastomotic (AS) or non ASs (NASs). Results. Computed tomography angiography confirmed HAS was present in 39 of 1232 patients (3.2%). This occurred at ≤90 and >90 days in 20 (1.6%) and 19 (1.5%), respectively. The incidence of biliary strictures (BSs) in the group with HAS was higher than the group without (13/39; 33% versus 85/1193; 7.1%, P = 0.01). BS occurred in 8/20 (40.0%) and 5/19 (26.3%) of the early and late groups, respectively. The need for biliary intervention increased if any liver function test result was ≥3× upper limit of normal (P = 0.019). Conclusions. BS occurs at a significantly higher rate in the presence of HAS. Onset of HAS at ≤90 or ≥90 days can both be associated with morbidity. Significant liver function test derangement at HAS diagnosis indicates a higher likelihood of biliary intervention for strictures.
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18
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Domanin M, Antonelli B, Crotti S, D'Alessio I, Fornoni G, Bottino N, Settembrini AM, Marongiu I, Suriano G, Tagliabue P, Carrara A, Alagna L, Trimarchi S, Pesenti A, Rossi G. Concurrent Thoracic Endovascular Aortic Repair and Liver Transplant: Multidisciplinary Management of Multiple Posttraumatic Lesions. Ann Vasc Surg 2020; 72:662.e7-662.e14. [PMID: 33227463 DOI: 10.1016/j.avsg.2020.09.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 01/19/2023]
Abstract
Association of thoracic and abdominal injuries in patients with major trauma is common. Under emergency conditions, it is often difficult to promptly perform a certain diagnosis and identify treatment priorities of life-threatening lesions. We present the case of a young man with combined thoracic and abdominal injuries after a motorcycle accident. Primary evaluation through echography and X-ray showed fluid within the hepatorenal recess and an enlarged mediastinum. Volume load, blood transfusions, and vasoactive agents were initiated to sustain circulation. Despite hemodynamic instability, we decided to perform computed tomographic angiography (CTA) scan that revealed a high-grade traumatic aortic pseudoaneurysm, multiple and severe areas of liver contusion, and a small amount of hemoperitoneum, without active bleeding spots. The patient was successfully submitted to thoracic endovascular aortic repair (TEVAR). Immediately after the end of the successful TEVAR, signs of massive abdominal bleeding revealed. Immediate explorative laparotomy was performed showing massive hepatic hemorrhage. After liver packing and Pringle's maneuver, control of bleeding was lastly obtained with hemostatic devices and selective cross-clamping of the right hepatic artery. The patient was then transferred to intensive care unit where, despite absence of further hemorrhage, hemodynamic instability, anuria, severe lactic acidosis together with liver necrosis indices appeared. A new CTA demonstrated massive parenchymal disruption within the right lobe of the liver and multiple hematomas in the left lobe. Considering the high-grade lesions of the hepatic vascular tree and liver failure, patient was listed for emergency liver transplantation (LT). LT occurred few hours later, and patient's clinical conditions rapidly improved even if the subsequent clinical course was characterized by a severe fungal infection because of immunosuppression. Evaluation of life-threatening lesions and treatment priorities, availability of different excellence skills, and multidisciplinary collaboration have a key role to achieve clinical success in such severe cases.
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Affiliation(s)
- Maurizio Domanin
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Vascular Surgery Unit, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Barbara Antonelli
- General Surgery and Liver Transplant Unit, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Crotti
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione I.R.C.C.S. S Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilenia D'Alessio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Fornoni
- General Surgery and Liver Transplant Unit, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Bottino
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione I.R.C.C.S. S Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Ines Marongiu
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione I.R.C.C.S. S Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Grazia Suriano
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione I.R.C.C.S. S Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Tagliabue
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione I.R.C.C.S. S Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Carrara
- Department of Pathophysiology and Transplantation, School of Medicine and Surgery, University of Milan, Milan, Italy; Department of General and Emergency Surgery, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Laura Alagna
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Vascular Surgery Unit, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Pesenti
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione I.R.C.C.S. S Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, School of Medicine and Surgery, University of Milan, Milan, Italy
| | - Giorgio Rossi
- General Surgery and Liver Transplant Unit, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, School of Medicine and Surgery, University of Milan, Milan, Italy
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Ito T, Botros M, Aziz A, Guorgui JG, Agopian VG, Farmer DG, Busuttil RW, Kaldas FM. Nonanastomotic Biliary Strictures After Liver Transplantation. Am Surg 2020; 86:1363-1367. [PMID: 33125271 DOI: 10.1177/0003134820964461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Biliary strictures constitute a major source of morbidity and mortality following liver transplantation (LT). However, studies on the impact of nonanastomotic biliary strictures (NABS) on grafts after LT are limited. 649 patients who underwent LT between January 2013 and June 2017 at our center were retrospectively analyzed and 2.6% (n = 17) of the recipients developed NABS following LT. There were no differences between recipients with and without NABS in indication of LT, graft ischemia time, and type of biliary anastomosis. The incidence of post-LT hepatic artery thrombosis (HAT) (odds ratio [OR]: 15.75, P < .001) and the use of livers from donation after cardiac death (DCD) donors (OR: 8.292, P = .004) were identified as independent significant predictors of NABS by multivariate analysis. Graft survival in those with NABS was significantly worse than in patients without NABS (1-, 3-, and 5-years survival: 64.7%, 57.5%, 0%, vs. 89.8%, 84.0%, 76.4%, P < .001). In conclusion, while the incidence of NABS in our study was relatively low compared to previous reports, NABS was still found to be associated with poor graft survival. Special attention should be paid to NABS occurrence in grafts that develop HAT as well as those from DCD donors.
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Affiliation(s)
- Takahiro Ito
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mina Botros
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Antony Aziz
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jacob G Guorgui
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vatche G Agopian
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Douglas G Farmer
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ronald W Busuttil
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Fady M Kaldas
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Ogiso S, Kamei H, Onishi Y, Kurata N, Jobara K, Kawashima H, Ogura Y. Decreased long‐term graft survival in persistent biliary complications after right‐lobe living‐donor liver transplantation. Clin Transplant 2019; 34:e13771. [DOI: 10.1111/ctr.13771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 11/05/2019] [Accepted: 12/08/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Satoshi Ogiso
- Transplantation Surgery Nagoya University Hospital Nagoya Japan
| | - Hideya Kamei
- Transplantation Surgery Nagoya University Hospital Nagoya Japan
| | - Yasuharu Onishi
- Transplantation Surgery Nagoya University Hospital Nagoya Japan
| | - Nobuhiko Kurata
- Transplantation Surgery Nagoya University Hospital Nagoya Japan
| | - Kanta Jobara
- Transplantation Surgery Nagoya University Hospital Nagoya Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Yasuhiro Ogura
- Transplantation Surgery Nagoya University Hospital Nagoya Japan
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