Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Liver Int. 2013 Sep;33(8):1287-92. doi: 10.1111/liv.12181. Epub 2013 Apr 21.
Biliary cast syndrome (BCS) is characterized by the retention of lithogenic material leading to obstructive cholangitis and subsequent liver damage. BCS after orthotopic liver transplantation (OLT) can lead to retransplantation or death.
Evaluation of aetiology, risk factors and outcome of BCS after OLT.
In a retrospective single centre analysis between 2002 and 2011, all OLT patients with BCS diagnosed by endoscopic retrograde cholangiography were identified and compared with a matched control group at a 2:1 ratio.
Thirty patients with BCS after OLT were identified (30/887, 3.4%). Seventy per cent of those patients (21/30) underwent transplantation in the Model for Endstage Liver Disease (MELD) score era. Median time to diagnosis after OLT was 255 days (IQR 107-621). Intensive care unit treatment after OLT was significantly longer in BCS patients [16 days (IQR 8-42) vs. 9 (IQR 7-17) days; P = 0.039]. In a multivariate analysis, hepatic artery stenosis (P = 0.04), biliary strictures (P = 0.032) and need for renal replacement therapy (P = 0.002) were significantly associated with BCS. Immunosuppressant regimen, operation time, cold or warm ischaemia time, graft size, acute cellular rejection and cytomegalovirus infections were not significantly different between both groups. Retransplantation rate and 12-month mortality were significantly higher with BCS (9/30, 30% vs. 4/60, 7%, P = 0.003).
BCS is a rare, but severe complication after OLT. Patients with hepatic artery stenosis, biliary strictures or renal replacement therapy have the highest risk to develop BCS and should therefore be monitored carefully.
胆汁铸型综合征（BCS）的特征是胆汁中形成结石的物质滞留，导致阻塞性胆管炎和随后的肝损伤。肝移植（OLT）后发生 BCS 可导致再次移植或死亡。
评估 OLT 后 BCS 的病因、危险因素和结果。
在 2002 年至 2011 年的回顾性单中心分析中，通过内镜逆行胰胆管造影术（ERCP）诊断为 OLT 后 BCS 的所有患者均被识别，并与 2:1 比例的匹配对照组进行比较。
共确定了 30 例 OLT 后 BCS 患者（30/887，3.4%）。这些患者中有 70%（21/30）在终末期肝病模型（MELD）评分时代接受了移植。OLT 后诊断的中位时间为 255 天（IQR 107-621）。OLT 后入住重症监护病房（ICU）的时间在 BCS 患者中明显更长[16 天（IQR 8-42）vs. 9 天（IQR 7-17）；P = 0.039]。在多变量分析中，肝动脉狭窄（P = 0.04）、胆管狭窄（P = 0.032）和需要肾脏替代治疗（P = 0.002）与 BCS 显著相关。免疫抑制方案、手术时间、冷或热缺血时间、移植物大小、急性细胞排斥反应和巨细胞病毒感染在两组之间无显著差异。BSC 患者的再次移植率和 12 个月死亡率明显更高（9/30，30%vs. 4/60，7%，P = 0.003）。
BCS 是 OLT 后的一种罕见但严重的并发症。有肝动脉狭窄、胆管狭窄或肾脏替代治疗的患者发生 BCS 的风险最高，因此应密切监测。
