de Vries A Boudewijn, Koornstra Jan J, Lo Ten Foe Jerome R, Porte Robert J, van den Berg Aad P, Blokzijl Hans, Verdonk Robert C
Department of Gastroenterology and Hepatology, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Microbiology, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Clin Transplant. 2016 Jan;30(1):81-9. doi: 10.1111/ctr.12664. Epub 2015 Dec 9.
Non-anastomotic biliary strictures (NAS) after orthotopic liver transplantation (OLT) have a negative influence on graft survival. Expert opinion suggests a negative effect of NAS on other important aspects of post-transplant care, although its impact is largely unknown as data are scarce.
This retrospective single center study analyzed data on healthcare consumption, use of ionizing radiation, infectious complications and development of highly resistant microorganisms (HRMO) in adult patients with NAS. A comparison with a matched control group was made.
Forty-three liver recipients with NAS and 43 controls were included. Hospital admissions were higher in patients with NAS. Most common reason for admission was bacterial cholangitis (BC), with 70% of the patients having at least one episode compared to 9% in the control group. In patients with NAS, 67% received at least one ERCP compared to 21% in the control group (p = 0.001). This resulted in a larger yearly received radiation dose for patients with NAS (p = 0.001). Frequency of intravenous antibiotic therapy was higher (p = 0.001) for patients with NAS, consistently resulting in a higher number of cultures found with HRMO (p = 0.012).
NAS after OLT have a negative effect on post-transplant care, increasing readmission rates, interventional procedures, exposure to ionizing radiation, use of antibiotics, and development of HRMO.
原位肝移植（OLT）后非吻合口胆管狭窄（NAS）对移植物存活有负面影响。专家意见表明NAS对移植后护理的其他重要方面有负面影响，尽管由于数据稀缺，其影响在很大程度上尚不清楚。
这项回顾性单中心研究分析了成年NAS患者的医疗消费、电离辐射使用、感染并发症和高度耐药微生物（HRMO）发生情况的数据。与匹配的对照组进行了比较。
纳入了43例NAS肝移植受者和43例对照。NAS患者的住院次数更多。最常见的入院原因是细菌性胆管炎（BC），70%的患者至少有一次发作，而对照组为9%。在NAS患者中，67%至少接受了一次内镜逆行胰胆管造影（ERCP），而对照组为21%（p = 0.001）。这导致NAS患者每年接受的辐射剂量更大（p = 0.001）。NAS患者静脉抗生素治疗的频率更高（p = 0.001），导致发现HRMO的培养物数量持续增加（p = 0.012）。
OLT后的NAS对移植后护理有负面影响，增加了再入院率、介入程序、电离辐射暴露、抗生素使用和HRMO的发生。
