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Tsaparas P, Machairas N, Ardiles V, Krawczyk M, Patrono D, Baccarani U, Cillo U, Aandahl EM, Cotsoglou C, Espinoza JL, Claría RS, Kostakis ID, Foss A, Mazzaferro V, de Santibañes E, Sotiropoulos GC. Liver transplantation as last-resort treatment for patients with bile duct injuries following cholecystectomy: a multicenter analysis. Ann Gastroenterol 2020; 34:111-118. [PMID: 33414630 PMCID: PMC7774661 DOI: 10.20524/aog.2020.0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022] Open
Abstract
Background Liver transplantation (LT) has been used as a last resort in patients with end-stage liver disease due to bile duct injuries (BDI) following cholecystectomy. Our study aimed to identify and evaluate factors that cause or contribute to an extended liver disease that requires LT as ultimate solution, after BDI during cholecystectomy. Methods Data from 8 high-volume LT centers relating to patients who underwent LT after suffering BDI during cholecystectomy were prospectively collected and retrospectively analyzed. Results Thirty-four patients (16 men, 18 women) with a median age of 45 (range 22-69) years were included in this study. Thirty of them (88.2%) underwent LT because of liver failure, most commonly as a result of secondary biliary cirrhosis. The median time interval between BDI and LT was 63 (range 0-336) months. There were 23 cases (67.6%) of postoperative morbidity, 6 cases (17.6%) of post-transplant 30-day mortality, and 10 deaths (29.4%) in total after LT. There was a higher probability that patients with concomitant vascular injury (hazard ratio 10.69, P=0.039) would be referred sooner for LT. Overall survival following LT at 1, 3, 5 and 10 years was 82.4%, 76.5%, 73.5% and 70.6%, respectively. Conclusion LT for selected patients with otherwise unmanageable BDI following cholecystectomy yields acceptable long-term outcomes.
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Affiliation(s)
- Peter Tsaparas
- 2 Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Peter Tsaparas, Nikolaos Machairas, Ioannis D. Kostakis, Georgios C. Sotiropoulos)
| | - Nikolaos Machairas
- 2 Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Peter Tsaparas, Nikolaos Machairas, Ioannis D. Kostakis, Georgios C. Sotiropoulos)
| | - Victoria Ardiles
- Division of Hepatobiliary Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (Victoria Ardiles, Johana Leiva Espinoza, Rodrigo Sanchez Claría, Eduardo de Santibañes)
| | - Marek Krawczyk
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland (Marek Krawczyk)
| | - Damiano Patrono
- General Surgery 2U, Liver Transplant Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy (Damiano Patrono)
| | - Umberto Baccarani
- Liver Transplant Unit, Department of Medicine, University of Udine, Udine, Italy (Umberto Baccarani)
| | - Umberto Cillo
- Hepatobiliary and Liver Transplant Unit, University of Padova School of Medicine, Padova, Italy (Umberto Cillo)
| | - Einar Martin Aandahl
- Surgical Department, Section of Transplant Surgery, Oslo University Hospital, Oslo, Norway (Einar Martin Aandahl, Aksel Foss)
| | - Christian Cotsoglou
- Department of Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, Milan, Italy (Christian Cotsoglou)
| | - Johana Leiva Espinoza
- Division of Hepatobiliary Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (Victoria Ardiles, Johana Leiva Espinoza, Rodrigo Sanchez Claría, Eduardo de Santibañes)
| | - Rodrigo Sanchez Claría
- Division of Hepatobiliary Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (Victoria Ardiles, Johana Leiva Espinoza, Rodrigo Sanchez Claría, Eduardo de Santibañes)
| | - Ioannis D Kostakis
- 2 Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Peter Tsaparas, Nikolaos Machairas, Ioannis D. Kostakis, Georgios C. Sotiropoulos)
| | - Aksel Foss
- Surgical Department, Section of Transplant Surgery, Oslo University Hospital, Oslo, Norway (Einar Martin Aandahl, Aksel Foss)
| | - Vincenzo Mazzaferro
- Department of Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, Milan, Italy (Christian Cotsoglou)
| | - Eduardo de Santibañes
- Division of Hepatobiliary Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (Victoria Ardiles, Johana Leiva Espinoza, Rodrigo Sanchez Claría, Eduardo de Santibañes)
| | - Georgios C Sotiropoulos
- 2 Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Peter Tsaparas, Nikolaos Machairas, Ioannis D. Kostakis, Georgios C. Sotiropoulos).,Department of General Visceral and Transplantation Surgery, University Hospital Essen, Germany (Georgios C. Sotiropoulos)
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