Biliary complications after adult-to-adult living-donor liver transplantation: An international multicenter study of 3633 cases.

Autor:	Li Z; Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Switzerland; Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada., Rammohan A; The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, India., Gunasekaran V; The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, India., Hong S; Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea., Chih-Yi Chen I; Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan., Kim J; Department of Surgery, Samsung Medical Center, Seoul, South Korea., Hervera Marquez KA; Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia., Hsu SC; Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan., Kirimker EO; Department of Surgery, Ankara University School of Medicine, Ankara, Turkey., Akamatsu N; Artificial Organ and Transplantation Division and Hepato-Biliary-Pancreatic Surgery, University of Tokyo, Tokyo, Japan., Shaked O; Division of Transplantation, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Finotti M; Division of Abdominal Transplantation, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA., Yeow M; Division of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore., Genedy L; Department of General Visceral and Transplant Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany., Dutkowski P; Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Switzerland., Nadalin S; Department of General Visceral and Transplant Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany., Boehnert MU; Department of Surgery, Division of HPB & Transplant Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands., Polak WG; Department of Surgery, Division of HPB & Transplant Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands., Bonney GK; Division of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore., Mathur A; Liver and Abdominal Transplant Surgery, Columbia University Irving Medical Center, New York, New York, USA., Samstein B; Liver and Abdominal Transplant Surgery, Columbia University Irving Medical Center, New York, New York, USA., Emond JC; Liver and Abdominal Transplant Surgery, Columbia University Irving Medical Center, New York, New York, USA., Testa G; Division of Abdominal Transplantation, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA., Olthoff KM; Division of Transplantation, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Rosen CB; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA., Heimbach JK; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA., Taner T; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA., Wong TC; Department of Surgery, The University of Hong Kong, Hong Kong, People's Republic of China., Lo CM; Department of Surgery, The University of Hong Kong, Hong Kong, People's Republic of China., Hasegawa K; Artificial Organ and Transplantation Division and Hepato-Biliary-Pancreatic Surgery, University of Tokyo, Tokyo, Japan., Balci D; Department of Surgery, Ankara University School of Medicine, Ankara, Turkey., Cattral M; Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada., Sapisochin G; Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada., Selzner N; Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada., Jeng LB; Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan., Broering D; Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia., Joh JW; Department of Surgery, Samsung Medical Center, Seoul, South Korea., Chen CL; Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan., Suh KS; Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea., Rela M; The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, India., Clavien PA; Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Switzerland. Electronic address: clavien@access.uzh.ch.
Jazyk:	angličtina
Zdroj:	American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2024 Jul; Vol. 24 (7), pp. 1233-1246. Date of Electronic Publication: 2024 Feb 28.
DOI:	10.1016/j.ajt.2024.02.023
Abstrakt:	In living-donor liver transplantation, biliary complications including bile leaks and biliary anastomotic strictures remain significant challenges, with incidences varying across different centers. This multicentric retrospective study (2016-2020) included 3633 adult patients from 18 centers and aimed to identify risk factors for these biliary complications and their impact on patient survival. Incidences of bile leaks and biliary strictures were 11.4% and 20.6%, respectively. Key risk factors for bile leaks included multiple bile duct anastomoses (odds ratio, [OR] 1.8), Roux-en-Y hepaticojejunostomy (OR, 1.4), and a history of major abdominal surgery (OR, 1.4). For biliary anastomotic strictures, risk factors were ABO incompatibility (OR, 1.4), blood loss >1 L (OR, 1.4), and previous abdominal surgery (OR, 1.7). Patients experiencing biliary complications had extended hospital stays, increased incidence of major complications, and higher comprehensive complication index scores. The impact on graft survival became evident after accounting for immortal time bias using time-dependent covariate survival analysis. Bile leaks and biliary anastomotic strictures were associated with adjusted hazard ratios of 1.7 and 1.8 for graft survival, respectively. The study underscores the importance of minimizing these risks through careful donor selection and preoperative planning, as biliary complications significantly affect graft survival, despite the availability of effective treatments. (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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