Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA.
Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, 4801 E Linwood Blvd, Kansas City, MO, 64128, USA.
Dig Dis Sci. 2019 Jul;64(7):2024-2030. doi: 10.1007/s10620-018-5438-0. Epub 2019 Jan 2.
Biliary strictures are a common complication among donation after cardiac death (DCD) liver transplantation (LT) recipients and may require multiple endoscopic retrograde cholangiopancreatography (ERCP) procedures. We evaluated the risk factors associated with development of biliary strictures in DCD LT recipients.
DCD LT recipients who underwent transplantation from 2012 to 2017 were divided into 2 groups: (a) those with anastomotic or non-anastomotic biliary strictures who required ERCP ("stricture group") and (b) those who did not require ERCP or had cholangiograms without evidence of biliary strictures ("non-stricture group"). Clinical data, cholangiograms and laboratory values at day 0 and day 7 after LT were compared between the two groups.
Forty-nine of the 100 DCD LT recipients underwent ERCP. Thirty-four of these 49 LT recipients had evidence of anastomotic or non-anastomotic biliary strictures (stricture group), while the remaining 66 LT recipients comprised the non-stricture group. Donor age was significantly higher in stricture group compared to non-stricture group (49.2 ± 1.8 vs 42.8 ± 1.57 years, respectively; p = 0.01). The stricture group had a significantly higher total bilirubin at day 0 (3.5 ± 0.37 vs 2.6 ± 0.21 mg/dL; p = 0.02) and INR at day 7 (1.24 ± 0.06 vs 1.13 ± 0.01; p = 0.048) compared to the non-stricture group. Multi-variate analysis demonstrated significant association between biliary strictures and total bilirubin at day 0 of LT and age of donor.
Biliary strictures occur frequently in DCD LT recipients and may be associated with older age of donor. Hyperbilirubinemia immediately after transplant and higher INR in the first 7 days after transplant may predict subsequent development of biliary strictures.
在心脏死亡后供体（DCD）肝移植（LT）受者中，胆瘘是一种常见的并发症，可能需要多次内镜逆行胰胆管造影（ERCP）。我们评估了与 DCD LT 受者胆瘘发展相关的危险因素。
将 2012 年至 2017 年间接受移植的 DCD LT 受者分为两组：（a）需要 ERCP 的吻合口或非吻合口胆瘘受者（“狭窄组”）和（b）不需要 ERCP 或胆管造影无胆瘘证据的受者（“非狭窄组”）。比较两组患者 LT 术后第 0 天和第 7 天的临床资料、胆管造影和实验室值。
在 100 例 DCD LT 受者中，49 例行 ERCP。其中 34 例 LT 受者有吻合口或非吻合口胆瘘证据（狭窄组），其余 66 例 LT 受者为非狭窄组。与非狭窄组相比，狭窄组供体年龄明显较高（分别为 49.2±1.8 岁和 42.8±1.57 岁；p=0.01）。狭窄组患者第 0 天总胆红素明显升高（3.5±0.37 毫克/分升与 2.6±0.21 毫克/分升；p=0.02），第 7 天 INR 也明显升高（1.24±0.06 毫克/分升与 1.13±0.01 毫克/分升；p=0.048）。多变量分析显示，LT 术后第 0 天总胆红素和供体年龄与胆瘘显著相关。
DCD LT 受者胆瘘发生率较高，可能与供体年龄较大有关。移植后立即出现高胆红素血症和移植后 7 天内 INR 升高可能预测随后发生胆瘘。
