Pape Thorben, von Garrel Tabea, Hunkemöller Anna M, Nalbant Bahar, Vondran Florian W R, Richter Nicolas, Heidrich Benjamin, Schneider Andrea, Taubert Richard, von Hahn Thomas, Wedemeyer Heiner, Seeliger Benjamin, Lenzen Henrike, Stahl Klaus
Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany.
Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
Abdom Radiol (NY). 2025 Apr;50(4):1699-1710. doi: 10.1007/s00261-024-04657-2. Epub 2024 Nov 5.
Biliary strictures are among the most common complications following liver transplantation (LT). If endoscopic retrograde cholangiography fails, percutaneous transhepatic biliary drainage (PTBD) may serve as an alternative approach. Description of clinical important short- and long-term outcomes as well as outcome prediction following PTBD after LT are scarce.
We analyzed outcomes of 56 liver-transplanted adults with biliary complications receiving a PTBD. We described the safety and longitudinal laboratory changes. We analyzed as endpoints, incidence of biliary complications, need for surgical biliary revision/re-LT and overall-survival at 12- and 60-months. We used simple comparison tests accordingly and performed competing risk analysis and multivariate competing risk regression as well as log-rank test and cox proportional hazard regression for further analysis.
PTBD procedures had a high technical success rate (98%) and tolerable safety profile. Multiple laboratory indicators improved during follow-up (37 patients with complete biochemical follow-up). Incidence of subsequent biliary complications was highly dependent on the nature of present biliary strictures (Anastomotic stricture (AS): adjusted SHR: 0.26, 95% CI: 0.09-0.78, p = 0.016). Need for surgical biliary revision/re-LT remained below 15%. 12-month survival was significantly better, if drainage into the small intestine was achieved at first attempt compared to completely external drainage (internal: 92.9 vs. external: 67.9%, p = 0.018). Patients with AS had a numerically higher long-term-survival and higher C-reactive-protein (CRP) and lower body-mass-index (BMI) at baseline were significantly associated with inferior short- and long-term-survival.
PTBD for biliary complications following LT had a high technical success and a tolerable safety profile. Incidence of subsequent biliary complications was highly dependent on the nature of biliary strictures and increased mortality was found in patients with higher CRP, lower BMI and failure of initial PTBD internalization.
胆管狭窄是肝移植（LT）后最常见的并发症之一。如果内镜逆行胆管造影失败，经皮经肝胆道引流（PTBD）可作为一种替代方法。关于LT后PTBD的临床重要短期和长期结局以及结局预测的描述很少。
我们分析了56例接受PTBD治疗的有胆管并发症的肝移植成年患者的结局。我们描述了安全性和纵向实验室变化。我们将胆管并发症的发生率、手术胆管修复/再次肝移植的需求以及12个月和60个月时的总生存率作为终点进行分析。我们相应地使用了简单比较测试，并进行了竞争风险分析和多变量竞争风险回归以及对数秩检验和Cox比例风险回归以进行进一步分析。
PTBD手术具有较高的技术成功率（98%）和可耐受的安全性。随访期间多个实验室指标有所改善（37例患者进行了完整的生化随访）。后续胆管并发症的发生率高度依赖于当前胆管狭窄的性质（吻合口狭窄（AS）：调整后的SHR：0.26，95%CI：0.09 - 0.78，p = 0.016）。手术胆管修复/再次肝移植的需求仍低于15%。与完全外引流相比，首次尝试即实现小肠内引流的患者12个月生存率显著更高（内引流：92.9% vs. 外引流：67.9%，p = 0.018）。AS患者的长期生存率在数值上更高，基线时较高的C反应蛋白（CRP）和较低的体重指数（BMI）与较差的短期和长期生存率显著相关。
LT后胆管并发症的PTBD具有较高的技术成功率和可耐受的安全性。后续胆管并发症的发生率高度依赖于胆管狭窄的性质，并且在CRP较高、BMI较低以及初始PTBD内引流失败的患者中发现死亡率增加。
