medigraphic.com
ISSN 2007-6800 (Print)

2025, Number 3

<< Back Next >>

Rev Mex Traspl 2025; 14 (3)

Stenotic complications of the biliary tract in post-liver transplant patients

Magaña-Mainero P, Hernández-Luna V, Navarro-Toledo GA, Sánchez-Cedillo IA, Charco-Cruz M, Florez-Zorrilla CW

Language: Spanish
References: 16
Page: 110-115
PDF size: 320.15 Kb.


ABSTRACT

Introduction: biliary complications are a major challenge in liver transplantation, with anastomotic and non-anastomotic strictures being the most common. This study evaluates the incidence and risk factors associated with biliary strictures in post-liver transplant patients. Material and methods: a retrospective cohort study was conducted from January 2018 to December 2019, analyzing clinical records of 56 liver transplant recipients. Donor and recipient variables, including demographic factors, liver disease etiology, surgical parameters, and postoperative complications, were assessed. Results: late anastomotic strictures (> 6 months) occurred in 44.6% of patients, significantly higher than the reported 10-15% in the literature. Non-anastomotic strictures were observed in 3.6% of cases, lower than expected (5-15%). Significant risk factors for anastomotic strictures included clinical rejection (relative risk [RR] 2.07, 95% confidence interval [95%CI]) and autoimmune liver disease (RR 1.7, 95%CI, p = 0.06). Surprisingly, donor leukocytosis (≥ 12,000 cel/mm3) was found to be a protective factor (RR 0.54, 95%CI). Conclusions: the incidence of anastomotic biliary strictures was significantly higher than reported in the literature, with autoimmune liver disease and graft rejection being the main risk factors. Non-anastomotic strictures were less frequent, potentially due to sample size limitations. Further research is needed to clarify the role of inflammation in biliary complications.


REFERENCES

  1. Lladó L, Fabregat J, Ramos E, Baliellas C, Torras J, Rafecas A. Complicaciones biliares tras el trasplante hepático. Cir Esp. 2012; 90 (1): 4-10.

  2. Verdonk RC, Buis CI, Porte RJ, Haagsma EB. Biliary complications after liver transplantation: a review. Scand J Gastroenterol Suppl. 2006; (243): 89-101.

  3. Sanada Y, Mizuta K, Urahashi T, Ihara Y, Wakiya T, Okada N et al. Co-occurrence of nonanastomotic biliary stricture and acute cellular rejection in liver transplant. Exp Clin Transplant. 2012; 10 (2): 176-179.

  4. Strasberg SM, Howard TK, Molmenti EP, Hertl M. Selecting the donor liver: risk factors for poor function after orthotopic liver transplantation. Hepatology. 1994; 20 (4): 829-838.

  5. Forrest EA, Reiling J, Lipka G, Fawcett J. Risk factors and clinical indicators for the development of biliary strictures post liver transplant: Significance of bilirubin. World J Transplant. 2017; 7 (6): 349-358.

  6. Koksal AS, Eminler AT, Parlak E, Gurakar A. Management of biliary anastomotic strictures after liver transplantation. Transplant Rev. 2017; 31 (3): 207-217.

  7. Costamagna G, Boskoski I. Current treatment of benign biliary strictures. Ann Gastroenterol. 2013; 26 (1): 37-40.

  8. De Vries Y, von Meijenfeldt FA, Porte RJ. Post-transplant cholangiopathy: classification, pathogenesis, and preventive strategies. Biochim Biophys Acta Mol Basis Dis. 2018; 1864 (4): 1507-1515.

  9. Ma Y, Wang GD, He XS, Li JL, Zhu XF, Hu RD. Clinical and pathological analysis of acute rejection following orthotopic liver transplantation. Chin Med J (Engl). 2009; 122 (12): 1400-1403.

  10. Meirelles JRF, Salvalaggio P, Rezende MB, Evangelista AS, Guardia BD, Matielo CE et al. Liver transplantation: history, outcomes and perspectives. Einstein (Sao Paulo). 2015; 13 (1): 149-152.

  11. Trotter JF. Liver transplantation around the world. Curr Opin Organ Transplant. 2017; 22 (2): 123-127.

  12. Hassouneh R, Beran A, Rosenheck M, Sosio J, Olchawa N, Kubal C et al. Risk factors for biliary strictures and leaks after living-donor liver transplantation: a systematic review and meta-analysis. J Gastrointest Surg. 2024; 28 (11): 1870-1882.

  13. Routh D, Sharma S, Naidu CS, Rao PP, Sharma AK, Ranjan P. Comparison of outcomes in ideal donor and extended criteria donor in deceased donor liver transplant: a prospective study. Int J Surg. 2014; 12 (8): 774-777.

  14. Scalea JR, Redfield RR, Foley DP. Liver transplant outcomes using ideal donation after circulatory death livers are superior to using older donation after brain death donor livers. Curr Opin Organ Transplant. 2016; 22 (2): 1197-1204.

  15. Sugawara Y, Makuuchi M, Sano K, Ohkubo T, Kaneko J, Teraoka T. Duct-to-duct biliary reconstruction in living donor liver transplantation. Transplant Proc. 2001; 33 (1-2): 1320-1321.

  16. Halliday N, Westbrook RH. Liver transplantation: need, indications, patient selection and pre-transplant care. Br J Hosp Med. 2017; 78 (5): 252-259.




2020     |     www.medigraphic.com