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 Vol 9: New Diagnosis and Therapy Model for Ischemic-Type Biliary Lesions following Liver Transplantation-A Retrospective Cohort Study.


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This article is from PLoS ONE, volume 9.AbstractIschemic-type biliary lesions ITBLs are a major cause of graft loss and mortality after orthotopic liver transplantation OLT. Impaired blood supply to the bile ducts may cause focal or extensive damage, resulting in intra- or extrahepatic bile duct strictures or dilatations that can be detected by ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and cholangiography. However, the radiographic changes occur at an advanced stage, after the optimal period for therapeutic intervention. Endoscopic retrograde cholangio-pancreatography ERCP and percutaneous transhepatic cholangiodrainage PTCD are the gold standard methods of detecting ITBLs, but these procedures cannot be used for continuous monitoring. Traditional methods of follow-up and diagnosis result in delayed diagnosis and treatment of ITBLs. Our center has used the early diagnosis and intervention model EDIM for the diagnosis and treatment of ITBLs since February 2008. This model mainly involves preventive medication to protect the epithelial cellular membrane of the bile ducts, regular testing of liver function, and weekly monitor of contrast-enhanced ultrasonography CEUS to detect ischemic changes to the bile ducts. If the liver enzyme levels become abnormal or CEUS shows low or no enhancement of the wall of the hilar bile duct during the arterial phase, early ERCP and PTCD are performed to confirm the diagnosis and to maintain biliary drainage. Compared with patients treated by the traditional model used prior to February 2008, patients in the EDIM group had a lower incidence of biliary tract infection 28.6% vs. 48.6%, P = 0.04, longer survival time of liver grafts 24±9.6 months vs. 17±12.3 months, P = 0.02, and better outcomes after treatment of ITBLs.



Autor: Zhang, Ying-cai; Qu, En-ze; Ren, Jie; Zhang, Qi; Zheng, Rong-qin; Yang, Yang; Chen, Gui-hua

Fuente: https://archive.org/







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