活体肝移植术后胆石症的危险因素、处理及其对移植肝结局的影响。
Risk factors and management of biliary stones after living donor liver transplant and its effect on graft outcome.
作者信息
Dabbous Hany, Elsayed Ashraf, Salah Manar, Montasser Iman, Atef Mohamed, Elmetenini Mahmoud
机构信息
Tropical Medicine Department, Ain Shams Center for Organ Transplantation, Ain Shams University, Cairo, Egypt.
Tropical Medicine Department, Ain Shams University, Cairo, Egypt.
出版信息
Front Med (Lausanne). 2022 Aug 23;9:927744. doi: 10.3389/fmed.2022.927744. eCollection 2022.
BACKGROUND
Bile stones are associated with numerous complications in liver transplant recipients. Endoscopic retrograde cholangiopancreatography (ERCP) has been proven to be safe and highly effective in dealing with most post-transplant biliary complications.
OBJECTIVE
The objective of this study was to identify the possible risk factors for bile stone formation on top of biliary stricture, the effects of stones on graft outcomes, and their management.
METHODS
This case-control study included 83 patients who underwent living donor liver transplant (LDLT) and suffered from postoperative biliary stricture with or without stones. Patients were divided into two groups. Group 1 ( = 55) included patients with biliary strictures with no stones and group 2 ( = 28) included patients who developed stones on top of biliary strictures. Data about the recipient and donor characteristics, surgical technique, blood lipid profile, immunosuppressive drugs, post-transplant complications, and interventions were collected from the medical records.
RESULTS
The frequency of hepatitis C virus (HCV) was significantly higher in group 2 compared to group 1 (71.4% vs. 47.3%, = 0.036). The body mass index (BMI) of the donors was significantly higher in group 2 than in group 1 (25.17 ± 2.53 vs. 23.68 ± 2.63, = 0.015). Episodes of acute rejection were significantly higher in group 2 than in group 1 (21.4% vs. 5.5%, = 0.027). The ERCP was sufficient in most of the cases (89.2%) to ensure biliary drainage. The identified independent risk factors for biliary stones included HCV, biliary drain, donor's BMI, and serum cholesterol level.
CONCLUSION
Positive HCV, biliary drain insertion, donor's BMI, and serum cholesterol level were independent risk factors for developing bile stones on top of biliary strictures. Biliary stones were associated with high episodes of acute graft rejection, and they could be successfully managed by the ERCP modality.
背景
胆结石与肝移植受者的多种并发症相关。内镜逆行胰胆管造影术（ERCP）已被证明在处理大多数移植后胆道并发症方面安全且高效。
目的
本研究的目的是确定除胆道狭窄外胆结石形成的可能危险因素、结石对移植结局的影响及其处理方法。
方法
本病例对照研究纳入了83例行活体肝移植（LDLT）且术后发生胆道狭窄伴或不伴结石的患者。患者分为两组。第1组（n = 55）包括无结石的胆道狭窄患者，第2组（n = 28）包括在胆道狭窄基础上出现结石的患者。从病历中收集受者和供者特征、手术技术、血脂谱、免疫抑制药物、移植后并发症及干预措施等数据。
结果
第2组丙型肝炎病毒（HCV）感染率显著高于第1组（71.4%对47.3%，P = 0.036）。第2组供者的体重指数（BMI）显著高于第1组（25.17±2.53对23.68±2.63，P = 0.015）。第2组急性排斥反应的发生率显著高于第1组（21.4%对5.5%，P = 0.027）。大多数病例（89.2%）通过ERCP足以确保胆道引流。确定的胆结石独立危险因素包括HCV、胆道引流、供者BMI和血清胆固醇水平。
结论
HCV阳性、插入胆道引流管、供者BMI和血清胆固醇水平是胆道狭窄基础上形成胆结石的独立危险因素。胆结石与急性移植排斥反应的高发生率相关，且可通过ERCP方式成功处理。
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