Endoscopic Management of Biliary Complications following Liver Transplantation after Donation from Cardiac Death DonorsReport as inadecuate




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Canadian Journal of Gastroenterology - Volume 26 2012, Issue 9, Pages 607-610

Original Article

Multi-Organ Transplant Program, London Health Sciences Centre, Canada

Department of Surgery, Division of General Surgery, The University of Western Ontario, London, Ontario, Canada

Division of Gastroenterology, The University of Western Ontario, London, Ontario, Canada

Received 25 November 2011; Accepted 14 January 2012

Copyright © 2012 Hindawi Publishing Corporation. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License CC BY-NC http:-creativecommons.org-licenses-by-nc-4.0-, which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.

Abstract

BACKGROUND Previous studies have shown a higher incidence of biliary complications following donation after cardiac death DCD liver transplantation compared with donation after brain death DBD liver transplantation. The endoscopic management of ischemic type biliary strictures in patients who have undergone DCD liver transplants needs to be characterized further.

METHODS: A retrospective institutional review of all patients who underwent DCD liver transplant from January 2006 to September 2011 was performed. These patients were compared with all patients who underwent DBD liver transplantation in the same time period. A descriptive analysis of all DCD patients who developed biliary complications and their subsequent endoscopic management was also performed.

RESULTS: Of the 36 patients who received DCD liver transplants, 25% developed biliary complications compared with 13% of patients who received DBD liver transplants P=0.062. All DCD allograft recipients who developed biliary complications became symptomatic within three months of transplantation. Ischemic type biliary strictures in DCD allograft recipients included disseminated biliary strictures in two patients, biliary strictures of the hepatic duct bifurcation in three patients and biliary strictures of the donor common hepatic duct in three patients.

CONCLUSIONS: There was a trend toward increasing incidence of total biliary complications in recipients of DCD liver allografts compared with those receiving DBD livers, and the rate of diffuse ischemic cholangiopathy was significantly higher. Focal ischemic type biliary strictures can be treated effectively in DCD liver transplant recipients with favourable results. Diffuse ischemic type biliary strictures in DCD liver transplant recipients ultimately requires retransplantation.





Author: Kris P Croome, Vivian McAlister, Paul Adams, Paul Marotta, William Wall, and Roberto Hernandez-Alejandro

Source: https://www.hindawi.com/



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