Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Biochim Biophys Acta Mol Basis Dis. 2018 Apr;1864(4 Pt B):1507-1515. doi: 10.1016/j.bbadis.2017.06.013. Epub 2017 Jun 20.
Biliary complications are the most frequent cause of morbidity, re-transplantation, and even mortality after liver transplantation. In general, biliary leakage and anastomotic and non-anastomotic biliary strictures (NAS) can be recognized. There is no consensus on the exact definition of NAS and different names and criteria have been used in literature. We propose to use the term post-transplant cholangiopathy for the spectrum of abnormalities of large donor bile ducts, that includes NAS, but also intraductal casts and intrahepatic biloma formation, in the presence of a patent hepatic artery. Combinations of these manifestations of cholangiopathy are not infrequently found in the same liver and ischemia-reperfusion injury is generally considered the common underlying mechanism. Other factors that contribute to post-transplant cholangiopathy are biliary injury due to bile salt toxicity and immune-mediated injury. This review provides an overview of the various types of post-transplant cholangiopathy, the presumed pathogenesis, clinical implications, and preventive strategies.
胆道并发症是肝移植后发病率、再次移植和甚至死亡的最常见原因。一般来说，可以识别出胆漏和吻合口及非吻合口胆道狭窄（NAS）。对于 NAS 的准确定义尚无共识，文献中使用了不同的名称和标准。我们建议使用移植后胆管病这一术语来描述供体胆管的异常范围，包括 NAS，但也包括肝内胆管铸型和胆内血肿的形成，同时肝动脉通畅。这些胆管病的表现常常同时存在于同一肝脏中，缺血再灌注损伤被普遍认为是共同的潜在机制。导致移植后胆管病的其他因素还有胆汁盐毒性引起的胆道损伤和免疫介导的损伤。这篇综述概述了各种类型的移植后胆管病、推测的发病机制、临床意义和预防策略。
