Gad Emad Hamdy, Ayoup Eslam, Aziz Amr M, Ibrahim Tarek, Elhelbawy Mostafa, Abd-Elsamee Mohammed Al-Sayed, Sallam Ahmed Nabil
Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt.
Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt.
Ann Med Surg (Lond). 2022 Apr 14;77:103577. doi: 10.1016/j.amsu.2022.103577. eCollection 2022 May.
Biliary complications (BCs) after adult to adult living donor liver transplantation (A-ALDLT) result in poor graft and patient survival. This study aimed to analyze these complications.
We retrospectively analyzed BCs in 245 recipients who underwent A-ALDLT using the right-lobe graft during 16 years period in our centre. The overall male/female ratio was 215/30.
One hundred fifty-five BCs affected 102 of our recipients (95 early (≤3months) and 60 late (≥3months)). They were classified as 67/245(27.3%) early bile leak, 10/245(4.1%) early biliary stricture, 44/245(17.9%) late biliary stricture, 4/245(1.6%) early cholangitis, 10/245(4.1%) late cholangitis, 14/245(5.7%) early biloma, and 6/245(2.4%) late cholangitic abscesses. Multiple biliary anastomoses were independently correlated with Post liver transplantation (LT) overall BCs; moreover, post LT hepatic artery thrombosis or stenosis (HAT/S) was an independent predictor of overall BCs, strictures and leaks. The mortality affected 96(39.2%) cases mostly due to sepsis, bleeding and multi-organ failure (MOF). On the other hand, the biliary related mortality was 10.6% of cases. Multiple cholangitic hepatic abscesses were significant predictors of poor graft and patient outcomes. Conclusions: Multiple biliary anastomoses and post LT HAT/S lead to a poor biliary outcome, furthermore, cholangitis, cholangitic abscesses and sepsis lead to poor graft and patient outcomes, so proper management of those variables is mandatory to improve outcomes after A-ARLLDLT.
成人对成人活体肝移植（A-ALDLT）后的胆道并发症（BCs）会导致移植物和患者生存率降低。本研究旨在分析这些并发症。
我们回顾性分析了在我们中心16年期间接受右叶移植物A-ALDLT的245例受者的BCs情况。总体男女比例为215/30。
155例BCs影响了102例受者（95例早期（≤3个月）和60例晚期（≥3个月））。它们被分类为67/245（27.3%）早期胆漏、10/245（4.1%）早期胆道狭窄、44/245（17.9%）晚期胆道狭窄、4/245（1.6%）早期胆管炎、10/245（4.1%）晚期胆管炎、14/245（5.7%）早期胆汁瘤和6/245（2.4%）晚期胆管性肝脓肿。多处胆肠吻合与肝移植（LT）后总体BCs独立相关；此外，LT后肝动脉血栓形成或狭窄（HAT/S）是总体BCs、狭窄和胆漏的独立预测因素。死亡率影响了96例（39.2%）病例，主要原因是败血症、出血和多器官功能衰竭（MOF）。另一方面，与胆道相关的死亡率为病例的10.6%。多处胆管性肝脓肿是移植物和患者预后不良的重要预测因素。结论：多处胆肠吻合和LT后HAT/S导致不良的胆道结局，此外，胆管炎、胆管性肝脓肿和败血症导致移植物和患者预后不良，因此对这些变量进行适当管理对于改善A-ARLLDLT后的结局至关重要。
