原位肝移植术后早期与晚期胆总管-胆总管吻合口狭窄的长期预后

Long-term outcomes of early compared to late onset choledochocholedochal anastomotic strictures after orthotopic liver transplantation.

作者信息

Satapathy Sanjaya K, Sheikh Imran, Ali Bilal, Yahya Fazal, Kocak Mehmet, Parsa Laxmi Babu, Eason James D, Vanatta Jason M, Nair Satheesh P

机构信息

Division of Transplantation, Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, TN, USA.

Department of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, TN, USA.

出版信息

Clin Transplant. 2017 Jul;31(7). doi: 10.1111/ctr.13003. Epub 2017 Jun 11.

DOI:10.1111/ctr.13003

PMID:28489291

Abstract

BACKGROUND

Endoscopic treatment of anastomotic biliary stricture (ABS) after liver transplantation (LT) has been proven to be effective and safe, but long-term outcomes of early compared to late onset ABS have not been studied. The aim of this study is to compare the long-term outcome of early ABS to late ABS.

METHODS

Of the 806 adult LT recipients (04/2006-12/2012), 93 patients met the criteria for inclusion, and were grouped into non-ABS (no stenosis on ERCP, n=41), early ABS (stenosis <90 days after LT, 18 [19.3%]), and late ABS (stenosis ≥90 days after LT, 34 [36.5%]). A propensity matched control group for the ABS group (n=42) was obtained matched for outcome variables for age, gender, and calculated MELD score at listing.

RESULTS

Mean number of ERCPs (2.33±1.3 vs 2.56±1.5, P=.69) were comparable between the groups; however, significantly better long-term resolution of the stricture was noted in the early ABS group (94.44% vs 67.65%, P=.04). Kaplan-Meier analysis revealed worst survival in the early ABS group compared to the non-ABS, late ABS, and control groups (P=.0001).

CONCLUSION

LT recipients with early ABS have inferior graft survival despite better response to endoscopic intervention.

摘要

背景

肝移植（LT）后吻合口胆管狭窄（ABS）的内镜治疗已被证明是有效且安全的，但早期与晚期发生的ABS的长期结局尚未得到研究。本研究的目的是比较早期ABS与晚期ABS的长期结局。

方法

在806例成年LT受者（2006年4月至2012年12月）中，93例患者符合纳入标准，被分为非ABS组（ERCP检查无狭窄，n = 41）、早期ABS组（LT后<90天出现狭窄，18例[19.3%]）和晚期ABS组（LT后≥90天出现狭窄，34例[36.5%]）。为ABS组（n = 42）获得了一个倾向匹配对照组，该对照组在年龄、性别和列出时计算的MELD评分等结局变量方面进行了匹配。

结果

两组之间的平均ERCP次数相当（2.33±1.3对2.56±1.5，P = 0.69）；然而，早期ABS组的狭窄长期缓解情况明显更好（94.44%对67.65%，P = 0.04）。Kaplan-Meier分析显示，与非ABS组、晚期ABS组和对照组相比，早期ABS组的生存率最差（P = 0.0001）。