Division of Gastroenterology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Gastrointest Endosc. 2011 Jun;73(6):1165-73. doi: 10.1016/j.gie.2011.01.024. Epub 2011 Apr 8.
Combined liver/small-bowel (L/SB) and multivisceral (MV) transplantation has been increasingly used with significant improvement in outcome.
To report our experience with pancreaticobiliary (PB) complications in this unique population.
Single-center cohort study using a prospectively completed database.
From May 1990 to November 2008, records of 271 consecutive patients who received 289 composite visceral grafts were retrospectively reviewed; 151 of the allografts were L/SB (52%) and the remaining 138 were MV.
Type, incidence, risk factors, clinical features, and management of PB complications.
PB complications were diagnosed in 44 patients with an incidence of 16%. Biliary complications developed in 20 patients (ampullary stenosis in 9, bile duct casts/stones in 6, and bile duct leaks in 5), pancreatic complications occurred in 19 patients (necrotizing pancreatitis in 7, edematous pancreatitis in 6, and pancreatic duct fistulae in 6), and combined biliary and pancreatic complications occurred in 5 patients. The risk of PB complications was significantly higher in MV graft recipients compared with L/SB recipients with a rate of 25% compared with 9%, respectively. ERCP was instrumental in the diagnosis and/or treatment of ampullary stenosis, bile duct casts and stones, bile duct leaks, and recurrent acute pancreatitis. Combined endoscopic and surgical intervention was required in most cases of pancreatic duct fistulae. Surgical intervention was performed in patients with pancreatic allograft necrosis and complex anastomotic biliary leaks.
Single-center study.
PB complications are common after composite visceral transplantation. Awareness of these complications is important to the transplantation team to ensure early diagnosis and appropriate intervention in an attempt to minimize morbidity and mortality.
联合肝/小肠（L/SB）和多器官（MV）移植的应用日益增多，其预后显著改善。
报告我们在这一独特人群中胰腺胆道（PB）并发症的经验。
使用前瞻性完成的数据库进行单中心队列研究。
1990 年 5 月至 2008 年 11 月，回顾性分析了 271 例连续接受 289 例复合内脏移植物的患者记录；151 例同种异体移植物为 L/SB（52%），其余 138 例为 MV。
PB 并发症的类型、发生率、危险因素、临床特征和处理。
44 例患者诊断为 PB 并发症，发生率为 16%。20 例患者发生胆道并发症（壶腹狭窄 9 例，胆管铸型/结石 6 例，胆管漏 5 例），19 例患者发生胰腺并发症（坏死性胰腺炎 7 例，水肿性胰腺炎 6 例，胰腺管瘘 6 例），5 例患者发生联合胆道和胰腺并发症。MV 移植物受者 PB 并发症的风险明显高于 L/SB 受者，分别为 25%和 9%。ERCP 对壶腹狭窄、胆管铸型/结石、胆管漏和复发性急性胰腺炎的诊断和/或治疗具有重要作用。大多数胰腺管瘘患者需要内镜和手术联合干预。对于胰腺移植物坏死和复杂吻合口胆管漏患者，进行了手术干预。
单中心研究。
复合内脏移植后 PB 并发症常见。移植团队对这些并发症有充分认识非常重要，以便早期诊断并进行适当干预，尽量减少发病率和死亡率。
