Tsaparas Peter, Machairas Nikolaos, Ardiles Victoria, Krawczyk Marek, Patrono Damiano, Baccarani Umberto, Cillo Umberto, Aandahl Einar Martin, Cotsoglou Christian, Espinoza Johana Leiva, Claría Rodrigo Sanchez, Kostakis Ioannis D, Foss Aksel, Mazzaferro Vincenzo, de Santibañes Eduardo, Sotiropoulos Georgios C
2 Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Peter Tsaparas, Nikolaos Machairas, Ioannis D. Kostakis, Georgios C. Sotiropoulos).
Division of Hepatobiliary Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (Victoria Ardiles, Johana Leiva Espinoza, Rodrigo Sanchez Claría, Eduardo de Santibañes).
Ann Gastroenterol. 2021;34(1):111-118. doi: 10.20524/aog.2020.0541. Epub 2020 Oct 2.
Liver transplantation (LT) has been used as a last resort in patients with end-stage liver disease due to bile duct injuries (BDI) following cholecystectomy. Our study aimed to identify and evaluate factors that cause or contribute to an extended liver disease that requires LT as ultimate solution, after BDI during cholecystectomy.
Data from 8 high-volume LT centers relating to patients who underwent LT after suffering BDI during cholecystectomy were prospectively collected and retrospectively analyzed.
Thirty-four patients (16 men, 18 women) with a median age of 45 (range 22-69) years were included in this study. Thirty of them (88.2%) underwent LT because of liver failure, most commonly as a result of secondary biliary cirrhosis. The median time interval between BDI and LT was 63 (range 0-336) months. There were 23 cases (67.6%) of postoperative morbidity, 6 cases (17.6%) of post-transplant 30-day mortality, and 10 deaths (29.4%) in total after LT. There was a higher probability that patients with concomitant vascular injury (hazard ratio 10.69, P=0.039) would be referred sooner for LT. Overall survival following LT at 1, 3, 5 and 10 years was 82.4%, 76.5%, 73.5% and 70.6%, respectively.
LT for selected patients with otherwise unmanageable BDI following cholecystectomy yields acceptable long-term outcomes.
肝移植（LT）已被用作胆囊切除术后因胆管损伤（BDI）导致终末期肝病患者的最后治疗手段。我们的研究旨在识别和评估胆囊切除术中发生BDI后导致或促成需要LT作为最终解决方案的晚期肝病的因素。
前瞻性收集并回顾性分析了8家大容量LT中心与胆囊切除术中发生BDI后接受LT的患者相关的数据。
本研究纳入了34例患者（16例男性，18例女性），中位年龄为45岁（范围22 - 69岁）。其中30例（88.2%）因肝衰竭接受LT，最常见的原因是继发性胆汁性肝硬化。BDI与LT之间的中位时间间隔为63个月（范围0 - 336个月）。术后有23例（67.6%）发生并发症，移植后30天内有6例（17.6%）死亡，LT后总计有10例死亡（29.4%）。伴有血管损伤的患者更有可能更早被转诊接受LT（风险比10.69，P = 0.039）。LT后1年、3年、5年和10年的总体生存率分别为82.4%、76.5%、73.5%和70.6%。
对于胆囊切除术后BDI难以处理的特定患者，肝移植可产生可接受的长期预后。
