Garcia Catherine R, Acosta Luis F, Mei Xiaonan, Berger Jonathan, Shah Malay B, Daily Michael F, Grigorian Alla, Gedaly Roberto
Transplant Division, Department of Surgery, University of Kentucky, College of Medicine, Lexington, KY.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Kentucky, College of Medicine, Lexington, KY.
Transplantation. 2017 Dec;101(12):2883-2887. doi: 10.1097/TP.0000000000001922.
Liver transplantation (LT) is rarely indicated in the management of iatrogenic bile duct injuries (IBDI), but occasionally, it becomes the only remaining therapy. The purpose of this study is to evaluate potential complications of IBDI and their impact on perioperative mortality, graft, and patient survival after LT.
The United Network for Organ Sharing database was queried for all LT performed in the United States between 1994 and 2014. Of the 101 238 liver transplants performed, 61 were related to IBDI. We performed a case matched analysis in a 5:1 ratio.
The median age for patients with IBDI was 50.16 ± 11.7 years with a mean Model End-Stage Liver Disease score of 22.6 ± 9.8. Patients receiving LT for IBDI were more likely women (54.1%, P = 0.001), had lower incidence of hepatitis C virus infection (4.9%, P = 0.001) and longer cold ischemic time (P = 0.001). The mean body mass index was 25.5 ± 5.2 in patients transplanted for IBDI. IBDI was recognized as the strongest independent predictor associated with eightfold increased risk of early graft loss (P = 0.001; odds ratio, 8.4) and a 2.9-fold increased risk of 30-day mortality after LT in a case matched analysis (P = 0.03).
IBDI is an uncommon but challenging indication for LT. These patients have significantly increased rates of early graft loss. IBDI is an independent factor related to increased risk of perioperative death after LT. Further studies are needed to determine the causes of perioperative complications and identify potential modifiable factors to improve outcomes in patients undergoing transplantation for IBDI.
肝移植（LT）在医源性胆管损伤（IBDI）的治疗中很少被采用，但偶尔会成为唯一可行的治疗方法。本研究的目的是评估IBDI的潜在并发症及其对LT围手术期死亡率、移植物和患者生存率的影响。
查询器官共享联合网络数据库，获取1994年至2014年在美国进行的所有肝移植病例。在101238例肝移植手术中，61例与IBDI相关。我们以5:1的比例进行了病例匹配分析。
IBDI患者的中位年龄为50.16±11.7岁，平均终末期肝病模型评分22.6±9.8。因IBDI接受LT的患者女性比例更高（54.1%，P = 0.001），丙型肝炎病毒感染发生率更低（4.9%，P = 0.001），冷缺血时间更长（P = 0.001）。接受IBDI移植患者的平均体重指数为25.5±5.2。在病例匹配分析中，IBDI被认为是与早期移植物丢失风险增加8倍（P = 0.001；优势比，8.4）和LT后30天死亡率风险增加2.9倍相关的最强独立预测因素（P = 0.03）。
IBDI是LT的一个罕见但具有挑战性的适应证。这些患者早期移植物丢失率显著增加。IBDI是与LT围手术期死亡风险增加相关的独立因素。需要进一步研究以确定围手术期并发症的原因，并识别潜在的可改变因素，以改善IBDI移植患者的预后。
