Castro Juliano Félix, Souza Ana Cláudia, de Faria Andrade Antônio Márcio, Corrêa Henrique Peragallos, Athanasio Bruno da Silva, Lima Cristiano Xavier
Division of Hepatobiliary Surgery, Department of Surgery, School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Brazil.
Transplant Unit, Felicio Rocho Hospital, Belo Horizonte, Brazil.
Transl Gastroenterol Hepatol. 2024 Jun 27;9:34. doi: 10.21037/tgh-23-110. eCollection 2024.
Liver transplantation (LT) is the best treatment for end-stage liver disease; however, biliary complications (BCs) still pose a significant challenge. Among the post-transplant BC, strictures and biliary fistulas are the most common. Biliary strictures are classified as anastomotic and non-anastomotic. Some previous studies suggest an association between post-transplant biliary strictures and cytomegalovirus (CMV) infection. In this study, we aimed to identify whether there is an association between CMV infection and biliary strictures in patients undergoing LT.
A retrospective study of 175 patients aged ≥18 years undergoing LT at Felicio Rocho Hospital between 2011 and 2017 was conducted. All included patients received grafts perfused with Institut Georges Lopez-1 (IGL-1) solution from brain-dead donors, survived post-transplantation for more than 120 days, and had a minimum follow-up of 12 months after LT. The diagnosis of CMV was made by antigenemia and biliary strictures by magnetic resonance cholangiopancreatography (MRCP).
The average age of the recipients was 54 years. Postoperative BCs occurred in 12% of transplants. The most common BC was stricture (9.1%), with a predominance of anastomotic strictures (AS) over non-AS (NAS) (87.5% 12.5%, respectively). CMV infection was confirmed in 22.9% of patients. In the univariate analysis, post-transplant CMV infection correlated with the development of BCs (P=0.01), as well as biliary strictures (P=0.008). In the multivariate analysis, however, only model for end-stage liver disease (MELD) >21 was a risk factor for the development of BCs in general (P=0.02) and biliary strictures (P=0.01).
CMV infection was not an independent risk factor for the development of non-anastomotic post-transplant biliary strictures in this study.
肝移植（LT）是终末期肝病的最佳治疗方法；然而，胆道并发症（BCs）仍然是一个重大挑战。在移植后BC中，狭窄和胆瘘最为常见。胆道狭窄分为吻合口狭窄和非吻合口狭窄。先前的一些研究表明，移植后胆道狭窄与巨细胞病毒（CMV）感染之间存在关联。在本研究中，我们旨在确定LT患者中CMV感染与胆道狭窄之间是否存在关联。
对2011年至2017年在费利西奥·罗乔医院接受LT的175例年龄≥18岁的患者进行回顾性研究。所有纳入患者均接受了来自脑死亡供体的用乔治·洛佩斯-1研究所（IGL-1）溶液灌注的移植物，移植后存活超过120天，且LT后至少随访12个月。CMV的诊断通过抗原血症进行，胆道狭窄通过磁共振胰胆管造影（MRCP）进行。
受者的平均年龄为54岁。12%的移植发生术后BCs。最常见的BC是狭窄（9.1%），其中吻合口狭窄（AS）多于非吻合口狭窄（NAS）（分别为87.5%和12.5%）。22.9%的患者确诊为CMV感染。在单变量分析中，移植后CMV感染与BCs的发生相关（P = 0.01），也与胆道狭窄相关（P = 0.008）。然而，在多变量分析中，只有终末期肝病模型（MELD）>21是一般BCs发生（P = 0.02）和胆道狭窄（P = 0.01）的危险因素。
在本研究中，CMV感染不是移植后非吻合口胆道狭窄发生的独立危险因素。
