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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 40 Issue 11
Nov.  2024
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Article Contents

Risk factors for biliary stricture and prognosis after orthotopic liver transplantation

DOI: 10.12449/JCH241119
Research funding:

Jilin Province Medical and Health Talents Special Project (JLSWSRCZX2021-074)

More Information
  • Corresponding author: YE Junfeng, yejunfeng@jlu.edu.cn (ORCID: 0000-0001-5330-9712)
  • Received Date: 2024-02-22
  • Accepted Date: 2024-04-08
  • Published Date: 2024-11-25
  •   Objective  To investigate the risk factors for biliary stricture within two years after orthotopic liver transplantation, and analyze the survival.  Methods  A retrospective analysis was performed for the data of 495 patients who underwent liver transplantation at Liver Transplantation Center of The First Hospital of Jilin University from January 2014 to January 2022, and according to the presence or absence of biliary stricture within two years after liver transplantation, the 495 patients were divided into stricture group with 89 patients and non-stricture group with 406 patients. The risk factors for biliary stricture and prognosis were analyzed. The independent-samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate Cox regression analyses were used for the analysis of risk factors, and the Kaplan-Meier method was used for survival analysis.  Results  Recipient sex (hazard ratio [HR]=1.808, 95% confidence interval [CI]: 1.055‍ ‍—‍ ‍3.098, P=0.031), preoperative total bilirubin of the recipient (HR=1.002, 95%CI: 1.001 ‍—‍ 1.003, P=0.001), cold ischemia time (HR=1.003, 95%CI: 1.001 ‍—‍ 1.005, P=0.007), history of abdominal surgery for the recipient (HR=3.851, 95%CI: 2.273 ‍—‍ 6.524, P<0.001), and mismatch of donor-recipient bile ducts (HR=1.962, 95%CI: 1.041 ‍—‍ 3.698, P=0.037) were identified as independent risk factors for biliary stricture within two years after transplantation. The median follow-up time was 4.09 years, and the 1-, 3-, and 5-year survival rates were 92.7%, 80.5%, and 75.4%, respectively, after liver transplantation. The onset of biliary stricture within two years after liver transplantation had no significant impact on the survival of patients undergoing orthotopic liver transplantation.  Conclusion  Recipient sex, preoperative total bilirubin of the recipient, cold ischemia time, history of abdominal surgery for the recipient, and mismatch of donor-recipient bile ducts are independent risk factors for biliary stricture within two years after transplantation. The onset of biliary stricture within two years after transplantation does not affect the survival time of patients undergoing orthotopic liver transplantation.

     

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  • [1]
    HIBI T, WEI CHIEH AK, CHI-YAN CHAN A, et al. Current status of liver transplantation in Asia[J]. Int J Surg, 2020, 82S: 4- 8. DOI: 10.1016/j.ijsu.2020.05.071.
    [2]
    MOY BT, BIRK JW. A review on the management of biliary complications after orthotopic liver transplantation[J]. J Clin Transl Hepatol, 2019, 7( 1): 61- 71. DOI: 10.14218/JCTH.2018.00028.
    [3]
    COTÉ GA, SLIVKA A, TARNASKY P, et al. Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: A randomized clinical trial[J]. JAMA, 2016, 315( 12): 1250- 1257. DOI: 10.1001/jama.2016.2619.
    [4]
    AMATEAU SK, KOHLI DR, DESAI M, et al. American Society for Gastrointestinal Endoscopy guideline on management of post-liver transplant biliary strictures: Methodology and review of evidence[J]. Gastrointest Endosc, 2023, 97( 4): 615- 637. e 11. DOI: 10.1016/j.gie.2022.10.006.
    [5]
    FENG YJ, LI JD, LI Q, et al. Progress in diagnosis and treatment of biliary anastomotic stricture after liver transplantation[J]. Organ Transplant, 2024, 15( 2): 297- 302. DOI: 10.3969/j.issn.1674-7445.2023240.

    冯彦杰, 李敬东, 李强, 等. 肝移植术后胆道吻合口狭窄的诊疗进展[J]. 器官移植, 2024, 15( 2): 297- 302. DOI: 10.3969/j.issn.1674-7445.2023240.
    [6]
    RAMMOHAN A, GOVIL S, VARGESE J, et al. Changing pattern of biliary complications in an evolving liver transplant unit[J]. Liver Transpl, 2017, 23( 4): 478- 486. DOI: 10.1002/lt.24736.
    [7]
    MAZILESCU LI, BERNHEIM I, TRECKMANN J, et al. Donor, recipient and surgeon sex and sex-concordance and their impact on liver transplant outcome[J]. J Pers Med, 2023, 13( 2): 281. DOI: 10.3390/jpm13020281.
    [8]
    LEGAZ I, NAVARRO NOGUERA E, BOLARÍN JM, et al. Patient sex in the setting of liver transplant in alcoholic liver disease[J]. Exp Clin Transplant, 2019, 17( 3): 355- 362. DOI: 10.6002/ect.2017.0302.
    [9]
    MAGRO B, TACELLI M, MAZZOLA A, et al. Biliary complications after liver transplantation: Current perspectives and future strategies[J]. Hepatobiliary Surg Nutr, 2021, 10( 1): 76- 92. DOI: 10.21037/hbsn.2019.09.01.
    [10]
    PENG T, ZHONG YL, LIN XD, et al. Analysis and numerical investigation of bile flow dynamics within the strictured biliary duct[J]. Int J Numer Method Biomed Eng, 2024, 40( 2): e3790. DOI: 10.1002/cnm.3790.
    [11]
    NEMES B, GÁMÁN G, DOROS A. Biliary complications after liver transplantation[J]. Expert Rev Gastroenterol Hepatol, 2015, 9( 4): 447- 466. DOI: 10.1586/17474124.2015.967761.
    [12]
    KALDAS FM, KORAYEM IM, RUSSELL TA, et al. Assessment of anastomotic biliary complications in adult patients undergoing high-acuity liver transplant[J]. JAMA Surg, 2019, 154( 5): 431- 439. DOI: 10.1001/jamasurg.2018.5527.
    [13]
    SUNDARAM V, JONES DT, SHAH NH, et al. Posttransplant biliary complications in the pre- and post-model for end-stage liver disease era[J]. Liver Transpl, 2011, 17( 4): 428- 435. DOI: 10.1002/lt.22251.
    [14]
    KEANE MG, DEVLIN J, HARRISON P, et al. Diagnosis and management of benign biliary strictures post liver transplantation in adults[J]. Transplant Rev, 2021, 35( 1): 100593. DOI: 10.1016/j.trre.2020.100593.
    [15]
    LIU DQ, SUN XD, QIU W, et al. Analysis of influencing factors for anastomotic biliary stricture after liver transplantation[J]. Chin J Dig Surg, 2022, 21( 2): 249- 255. DOI: 10.3760/cma.j.cn115610-20211129-00602.

    刘大群, 孙晓东, 邱伟, 等. 影响肝移植术后胆管吻合口狭窄的相关因素分析[J]. 中华消化外科杂志, 2022, 21( 2): 249- 255. DOI: 10.3760/cma.j.cn115610-20211129-00602.
    [16]
    FASULLO M, SHAH T, ZHOU HP, et al. Post-transplant biliary strictures: An updated review[J]. Semin Liver Dis, 2022, 42( 2): 225- 232. DOI: 10.1055/s-0042-1744144.
    [17]
    VRIES YD, von MEIJENFELDT FA, PORTE RJ. Post-transplant cholangiopathy: Classification, pathogenesis, and preventive strategies[J]. Biochim Biophys Acta Mol Basis Dis, 2018, 1864( 4 Pt B): 1507- 1515. DOI: 10.1016/j.bbadis.2017.06.013.
    [18]
    HU XW, LI T. Diagnosis and treatment of common biliary complications after orthotopic liver transplantation in adults[J]. Organ Transplant, 2022, 13( 5): 569- 576. DOI: 10.3969/j.issn.1674-7445.2022.05.004.

    胡鑫文, 李亭. 成人原位肝移植术后常见胆道并发症的诊疗[J]. 器官移植, 2022, 13( 5): 569- 576. DOI: 10.3969/j.issn.1674-7445.2022.05.004.
    [19]
    PARENTE A, TIROTTA F, PINI A, et al. Machine perfusion techniques for liver transplantation- A meta-analysis of the first seven randomized-controlled trials[J]. J Hepatol, 2023, 79( 5): 1201- 1213. DOI: 10.1016/j.jhep.2023.05.027.
    [20]
    AGOPIAN VG, PETROWSKY H, KALDAS FM, et al. The evolution of liver transplantation during 3 decades: Analysis of 5347 consecutive liver transplants at a single center[J]. Ann Surg, 2013, 258( 3): 409- 421. DOI: 10.1097/SLA.0b013e3182a15db4.
    [21]
    SENTER-ZAPATA M, KHAN AS, SUBRAMANIAN T, et al. Patient and graft survival: Biliary complications after liver transplantation[J]. J Am Coll Surg, 2018, 226( 4): 484- 494. DOI: 10.1016/j.jamcollsurg.2017.12.039.
    [22]
    JARLOT-GAS C, MUSCARI F, MOKRANE FZ, et al. Management of anastomotic biliary stricture after liver transplantation and impact on survival[J]. HPB, 2021, 23( 8): 1259- 1268. DOI: 10.1016/j.hpb.2020.12.008.
    [23]
    MATAR AJ, ROSS-DRISCOLL K, KENNEY L, et al. Biliary complications following adult deceased donor liver transplantation: Risk factors and implications at a high-volume US center[J]. Transplant Direct, 2021, 7( 10): e754. DOI: 10.1097/TXD.0000000000001207.
    [24]
    AXELROD DA, LENTINE KL, XIAO HL, et al. National assessment of early biliary complications following liver transplantation: Incidence and outcomes[J]. Liver Transpl, 2014, 20( 4): 446- 456. DOI: 10.1002/lt.23829.
    [25]
    ZHANG CC, RUPP C, EXARCHOS X, et al. Scheduled endoscopic treatment of biliary anastomotic and nonanastomotic strictures after orthotopic liver transplantation[J]. Gastrointest Endosc, 2023, 97( 1): 42- 49. DOI: 10.1016/j.gie.2022.08.034.
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