The real incidence of biliary tract complications after adult liver transplantation: the role of the prospective routine use of cholangiography during post-transplant follow-up
| Autor: | Dhoha Kourta, Kente Baami-Mariza, Pierre Goffette, Marwan Nadiri, Kevin Ackenine, Olga Ciccarelli, Jan Lerut, Pamela Baldin, Laurent Coubeau, Samuele Iesari, Eliano Bonaccorsi-Riani, Tom G. Moreels, Julie Navez |
|---|---|
| Přispěvatelé: | UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IONS/NEUR - Clinical Neuroscience, UCL - (SLuc) Service de radiologie, UCL - (SLuc) Service d'anatomie pathologique, UCL - (SLuc) Service de gastro-entérologie |
| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Biliary Tract Diseases Liver transplantation Gastroenterology Biliary tract complications Cholangiography Postoperative Complications Internal medicine Biopsy medicine Humans Prospective Studies Risk factor Biliary Tract Interventional radiology canalicular proliferation Transplantation medicine.diagnostic_test business.industry Incidence Liver Transplantation Biliary tract Liver biopsy business Interventional endoscopy Follow-Up Studies |
| Zdroj: | Transplant international, Vol. 34, no. 2, p. 245-258 (2021) |
| ISSN: | 1432-2277 |
| Popis: | Biliary tract complications (BTCs) still burden liver transplantation (LT). The wide reporting variability highlights the absence of systematic screening. From 2000 to 2009, simultaneous liver biopsy and direct biliary visualization were prospectively performed in 242 recipients at 3 and 6 months (n = 212, 87.6%) or earlier when indicated (n = 30, 12.4%). Median follow-up was 148 (107-182) months. Seven patients (2.9%) experienced postprocedural morbidity. BTCs were initially diagnosed in 76 (31.4%) patients; 32 (42.1%) had neither clinical nor biological abnormalities. Acute cellular rejection (ACR) was present in 27 (11.2%) patients and in 6 (22.2%) BTC patients. Nine (3.7%) patients with normal initial cholangiography developed BTCs after 60 (30-135) months post-LT. BTCs directly lead to 7 (2.9%) re-transplantations and 14 (5.8%) deaths resulting in 18 (7.4%) allograft losses. Bile duct proliferation at 12-month biopsy proved an independent risk factor for graft loss (P = 0.005). Systematic biliary tract and allograft evaluation allows the incidence and extent of biliary lesions to be documented more precisely and to avoid erroneous treatment of ACR. The combination 'abnormal biliary tract-canalicular proliferation' is an indicator of worse graft outcome. BTCs are responsible for important delayed allograft and patient losses. These results underline the importance of life-long follow-up and appropriate timing for re-transplantation. |
| Databáze: | OpenAIRE |
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