Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Liver Transpl. 2011 Apr;17(4):428-35. doi: 10.1002/lt.22251.
Biliary complications remain a cause of morbidity after liver transplantation. The aim of this study was to determine whether changes in clinical practice in the era of the Model for End-Stage Liver Disease (MELD) has affected biliary complications after liver transplantation. We retrospectively reviewed all deceased donor liver transplants at a single center. Patients were categorized as pre- or post-MELD (transplant before or after February 28, 2002). A total of 1798 recipients underwent deceased donor liver transplants. Biliary stricture was more common in the post-MELD era (15.4% versus 6.4%, P < 0.001). The strongest risk factors for stricture development were donor age (odds ratio [OR] = 1.01), presence of a prior bile leak (OR = 2.24), use of choledochocholedochostomy (OR = 2.22), and the post-MELD era (OR = 2.30). Bile leak was more common in the pre-MELD era (7.5% versus 4.9%, P = 0.02), with use of a T-tube as the strongest risk factor (OR = 3.38). Surgical factors did not influence the biliary complication rate. In conclusion, even when employing multivariate analysis to allow for factors that may influence biliary strictures, transplant in the post-MELD era was an independent predictor for stricture development. Further studies are warranted to determine the etiology of this increase.
胆道并发症仍然是肝移植后发病率的一个原因。本研究旨在确定终末期肝病模型（MELD）时代临床实践的变化是否影响肝移植后的胆道并发症。我们回顾性分析了单中心的所有尸体供肝移植患者。患者分为 MELD 前（移植时间在 2002 年 2 月 28 日之前）和 MELD 后（移植时间在 2002 年 2 月 28 日之后）。共有 1798 例受体接受了尸体供肝移植。MELD 后时代胆道狭窄更为常见（15.4%对 6.4%，P < 0.001）。狭窄发展的最强危险因素是供者年龄（比值比[OR] = 1.01）、先前存在胆漏（OR = 2.24）、使用胆肠吻合术（OR = 2.22）和 MELD 后时代（OR = 2.30）。MELD 前时代胆漏更为常见（7.5%对 4.9%，P = 0.02），使用 T 管是最强的危险因素（OR = 3.38）。手术因素并不影响胆道并发症的发生率。总之，即使采用多变量分析来考虑可能影响胆道狭窄的因素，MELD 后时代的移植也是狭窄发展的独立预测因素。需要进一步研究确定这种增加的病因。
