Endoscopic retrograde cholangiopancreatography and liver biopsy in the evaluation of elevated liver function tests after liver transplantation
| Autor: | Samuel Han, Michael Kriss, Augustin Attwell |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Abnormal liver tests Acute cellular rejection medicine.medical_treatment Observational Study Liver transplantation Anastomosis Gastroenterology 03 medical and health sciences 0302 clinical medicine Endoscopic retrograde cholangiopancreatography Internal medicine medicine Adverse effect Hepatology medicine.diagnostic_test business.industry Retrospective cohort study Liver biopsy Anastomotic biliary stricture 030220 oncology & carcinogenesis Abnormal Liver Function Test 030211 gastroenterology & hepatology business |
| Zdroj: | World Journal of Hepatology |
| ISSN: | 1948-5182 |
| Popis: | Background Abnormal liver function tests (LFTs) in post-liver transplant (LT) patients pose a challenge in the timing and selection of diagnostic modalities. There are little data regarding the accuracy of endoscopic retrograde cholangiopancreatography (ERCP) and liver biopsy (LB) in diagnosing post-transplant complications. Aim To evaluate the diagnostic performance of ERCP and LB in patients with non-vascular post-LT complications. Methods This single-center retrospective study evaluated patients undergoing both ERCP and LB for evaluation of elevated LFTs within 6 mo of LT from 2000 to 2017. Diagnostic operating characteristics including accuracy, sensitivity and specificity for various diagnoses were calculated for ERCP and LB. The R factor (ratio of alkaline phosphatase to alanine aminotransferase) was also calculated for each patient. Results Of the 1284 patients who underwent LT, 91 patients (74.7% males, mean age of 51) were analyzed. Anastomotic strictures (AS, 24.2%), acute cellular rejection (ACR, 11%) and concurrent AS/ACR (14.3%) were the most common diagnoses. ERCP carried an accuracy of 79.1% (95%CI: 69.3-86.9), LB had an accuracy of 93.4% (95%CI: 86.2-97.5), and the combination of the two had an accuracy of 100% (95%CI: 96-100). There was no difference between patients with AS and ACR in mean R factor (AS: 1.9 vs ACR: 1.1, P = 0.24). Adverse events did not differ between the two tests (ERCP: 3.1% vs LB: 1.1%, P = 0.31). Conclusion In patients with abnormal LFTs after LT without vascular complications, the combination of LB and ERCP carries low risk and improves diagnostic accuracy over either test alone. |
| Databáze: | OpenAIRE |
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