Forrest Elizabeth Ann, Reiling Janske, Lipka Geraldine, Fawcett Jonathan
Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia.
World J Transplant. 2017 Dec 24;7(6):349-358. doi: 10.5500/wjt.v7.i6.349.
To identify risk factors associated with the formation of biliary strictures post liver transplantation over a period of 10-year in Queensland.
Data on liver donors and recipients in Queensland between 2005 and 2014 was obtained from an electronic patient data system. In addition, intra-operative and post-operative characteristics were collected and a logistical regression analysis was performed to evaluate their association with the development of biliary strictures.
Of 296 liver transplants performed, 285 (96.3%) were from brain dead donors. Biliary strictures developed in 45 (15.2%) recipients. Anastomotic stricture formation ( = 25, 48.1%) was the commonest complication, with 14 (58.3%) of these occurred within 6-mo of transplant. A percutaneous approach or endoscopic retrograde cholangiography was used to treat 17 (37.8%) patients with biliary strictures. Biliary reconstruction was initially or ultimately required in 22 (48.9%) patients. In recipients developing biliary strictures, bilirubin was significantly increased within the first post-operative week (Day 7 total bilirubin 74 μmol/L 49 μmol/L, = 0.012). In both univariate and multivariate regression analysis, Day 7 total bilirubin > 55 μmol/L was associated with the development of biliary stricture formation. In addition, hepatic artery thrombosis and primary sclerosing cholangitis were identified as independent risk factors.
In addition to known risk factors, bilirubin levels in the early post-operative period could be used as a clinical indicator for biliary stricture formation.
确定昆士兰州10年间肝移植术后胆管狭窄形成的相关危险因素。
从电子患者数据系统获取2005年至2014年昆士兰州肝供体和受体的数据。此外，收集术中及术后特征，并进行逻辑回归分析以评估它们与胆管狭窄发生的相关性。
在296例肝移植手术中，285例（96.3%）来自脑死亡供体。45例（15.2%）受体发生胆管狭窄。吻合口狭窄形成（n = 25，48.）是最常见的并发症，其中14例（58.3%）发生在移植后6个月内。17例（37.8%）胆管狭窄患者采用经皮途径或内镜逆行胆管造影进行治疗。22例（48.9%）患者最初或最终需要进行胆管重建。在发生胆管狭窄的受体中，术后第一周内胆红素显著升高（术后第7天总胆红素74 μmol/L对49 μmol/L，P = 0.012）。在单因素和多因素回归分析中，术后第7天总胆红素>55 μmol/L与胆管狭窄形成相关。此外，肝动脉血栓形成和原发性硬化性胆管炎被确定为独立危险因素。
除已知危险因素外，术后早期胆红素水平可作为胆管狭窄形成的临床指标。
