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anastomotic stricture liver transplant

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https://www.readbyqxmd.com/read/28757315/liver-transplant-related-anastomotic-biliary-strictures-a-novel-rapid-safe-radiation-sparing-and-cost-effective-management-approach
#1
Monique T Barakat, Robert J Huang, Nirav C Thosani, Abhishek Choudhary, Mohit Girotra, Subhas Banerjee
BACKGROUND AND AIMS: Biliary strictures after orthotopic liver transplantation (OLT) are typically managed by sequential ERCP procedures, with incremental dilation of the stricture and stent exchange (IDSE) and placement of new stents. This approach resolves >80% of strictures after 12 months, but requires costly, lengthy ERCPs with significant patient radiation exposure. Increasing awareness of the harmful effects of radiation, escalating health care costs, and decreasing reimbursement for procedures mandate maximal efficiency in performing ERCP...
July 27, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28735936/combined-surgical-and-transhepatic-rendezvous-procedure-for-relieving-anastomotic-biliary-obstruction-in-children-with-liver-transplants
#2
John Crowley, Kyle Soltys, Rakesh Sindhi, Kevin Baskin, Sabri Yilmaz, Orrie Close, Avinash Medsinge
Four children (3 boys and 1 girl, age 1.4-9.4 y) presented 2-70 months after liver transplantation (mean 26 months) with high-grade narrowing at the surgical anastomosis that could not be crossed at percutaneous transhepatic cholangiography. Each patient was treated with a combined surgical and interventional radiology "rendezvous" procedure. Biliary drainage catheters were left in place for an average of 6 months after the procedure. At a mean 7.5 months after biliary drainage catheter removal, all children were catheter-free without clinical or biochemical evidence of biliary stricture recurrence...
August 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/28690174/clinical-outcomes-of-donation-after-circulatory-death-liver-transplantation-in-primary-sclerosing-cholangitis
#3
Palak J Trivedi, Irene Scalera, Emma Slaney, Richard W Laing, Bridget Gunson, Gideon M Hirschfield, Andrea Schlegel, James Ferguson, Paolo Muiesan
BACKGROUND & AIM: Primary sclerosing cholangitis (PSC) is a progressive fibro-inflammatory cholangiopathy for which liver transplantation is the only life-extending intervention. These patients may benefit from accepting liver donation after circulatory death (DCD), however their subsequent outcome is unknown. The aim of this study was to determine the clinical impact of using DCD liver grafts in patients specifically undergoing transplantation for PSC. METHODS: Clinical outcomes were prospectively evaluated in PSC patients undergoing transplantation from 2006 to 2016 stratified by donor type (DCD, n=35 vs...
July 8, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28652659/single-operator-cholangioscopy-for-biliary-complications-in-liver-transplant-recipients
#4
Anna Hüsing-Kabar, Hauke Sebastian Heinzow, Hartmut Hans-Jürgen Schmidt, Carina Stenger, Hans Ulrich Gerth, Michele Pohlen, Gerold Thölking, Christian Wilms, Iyad Kabar
AIM: To evaluate cholangioscopy in addition to endoscopic retrograde cholangiopancreatography (ERCP) for management of biliary complications after liver transplantation (LT). METHODS: Twenty-six LT recipients with duct-to-duct biliary reconstruction who underwent ERCP for suspected biliary complications between April and December 2016 at the university hospital of Muenster were consecutively enrolled in this observational study. After evaluating bile ducts using fluoroscopy, cholangioscopy using a modern digital single-operator cholangioscopy system (SpyGlass DS™) was performed during the same procedure with patients under conscious sedation...
June 14, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28645651/post-transplant-cholangiopathy-classification-pathogenesis-and-preventive-strategies
#5
REVIEW
Yvonne de Vries, Fien A von Meijenfeldt, Robert J Porte
Biliary complications are the most frequent cause of morbidity, re-transplantation, and even mortality after liver transplantation. In general, biliary leakage and anastomotic and non-anastomotic biliary strictures (NAS) can be recognized. There is no consensus on the exact definition of NAS and different names and criteria have been used in literature. We propose to use the term post-transplant cholangiopathy for the spectrum of abnormalities of large donor bile ducts, that includes NAS, but also intraductal casts and intrahepatic biloma formation, in the presence of a patent hepatic artery...
June 20, 2017: Biochimica et Biophysica Acta
https://www.readbyqxmd.com/read/28624651/efficacy-and-optimal-duration-of-metallic-stent-in-the-management-of-refractory-anastomotic-stricture-after-liver-transplantation
#6
Sunguk Jang, Mansour A Parsi, Rocio Lopez, Amit Bhatt, John J Vargo
BACKGROUND: Anastomotic bile duct stricture (ABS) remains as one of the most common complications in liver transplant patients. Current practice of endoscopic retrograde cholangiopancreatography (ERCP) with insertion of plastic stent (PS) often requires multiple procedures before achieving stricture resolution. To date, studies utilizing covered self-expandable metallic stent (cSEMS) in ABS management reported varying degree of efficacy. The aim of this study was to analyze long term efficacy of cSEMS in patients with ABS, and identifying factor(s) influencing the probability of stricture resolution...
June 14, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28624111/biliary-complications-after-liver-transplantation-recent-developments-in-etiology-diagnosis-and-endoscopic-treatment
#7
REVIEW
Floris J M Roos, Jan-Werner Poley, Wojciech G Polak, Herold J Metselaar
Biliary complications are considered to be the Achilles' heel of liver transplantation. The most common complications are leaks and bile duct strictures. Strictures can arise at the level of the anastomosis (anastomotic strictures; AS) or at other locations in the biliary tree (non-anastomotic strictures; NAS). Endoscopic treatment via endoscopic retrograde cholangiopancreatography (ERCP) is considered to be the preferred therapy for these complications. This review will focus on the diagnostic modalities, new insights in etiology of biliary complications and outcomes after different endoscopic therapies, in both deceased donor transplantation and living-donor liver transplantations...
April 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28605573/prediction-of-biliary-anastomotic-stricture-after-deceased-donor-liver-transplantation-the-impact-of-platelet-counts
#8
Kazuhiro Takahashi, Shunji Nagai, Krishna G Puchakayala, Mohamed Safwan, Masahiko Gosho, Amy Y Li, William J Kane, Priyanka L Singh, Michael D Rizzari, Kelly M Collins, Atsushi Yoshida, Marwan S Abouljoud, Gabriel T Schnickel
Biliary stricture is a common cause of morbidity after liver transplantation (LT). This study aimed to determine the risk factors for post-transplant biliary anastomotic strictures (BAS), focusing on perioperative platelet counts. We enrolled 771 consecutive recipients who underwent ABO-identical/compatible deceased donor LT with duct-to-duct biliary reconstruction from January 2000 to June 2012. BAS was identified in 142 cases. The median time for stricture development was 176 days. Preoperative and postoperative platelet counts within 5 days after LT were significantly lower in patients with BAS than those without BAS...
June 12, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28515595/percutaneous-transhepatic-techniques-for-management-of-biliary-anastomotic-strictures-in-living-donor-liver-transplant-recipients
#9
Chinmay B Kulkarni, Nirmal K Prabhu, Nazar P Kader, Ramiah Rajeshkannan, Sreekumar K Pullara, Srikanth Moorthy
AIM: To retrospectively analyze the percutaneous transhepatic techniques and their outcome in the management of biliary strictures in living donor liver transplant (LDLT) recipients. MATERIALS AND METHODS: We retrieved the hospital records of 400 LDLT recipients between 2007 and 2015 and identified 45 patients with biliary strictures. Among them, 17 patients (37.8%) (Male: female = 13:4; mean age, 36.1 ± 17.5 years) treated by various percutaneous transhepatic biliary techniques alone or in combination with endoscopic retrograde cholangiopancreatography (ERCP) were included in the study...
January 2017: Indian Journal of Radiology & Imaging
https://www.readbyqxmd.com/read/28489291/long-term-outcomes-of-early-compared-to-late-onset-choledochocholedochal-anastomotic-strictures-after-orthotopic-liver-transplantation
#10
Sanjaya K Satapathy, Imran Sheikh, Bilal Ali, Fazal Yahya, Mehmet Kocak, Laxmi Babu Parsa, James D Eason, Jason M Vanatta, Satheesh P Nair
BACKGROUND: Endoscopic treatment of anastomotic biliary stricture (ABS) after liver transplantation (LT) has been proven to be effective and safe, but long-term outcomes of early compared to late onset ABS have not been studied. The aim of this study is to compare the long-term outcome of early ABS to late ABS. METHODS: Of the 806 adult LT recipients (04/2006-12/2012), 93 patients met the criteria for inclusion, and were grouped into non-ABS (no stenosis on ERCP, n=41), early ABS (stenosis <90 days after LT, 18 [19...
May 10, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28455159/metal-versus-plastic-stents-for-anastomotic-biliary-strictures-after-liver-transplantation-a-randomized-controlled-trial
#11
Fernanda Prata Martins, Gustavo Andrade De Paulo, Mônica L C Contini, Angelo Paulo Ferrari
BACKGROUND AND AIMS: Biliary anastomotic stricture occurs in 15% to 20% of patients after deceased orthotopic liver transplantation (OLT). It is usually treated endoscopically with multiple plastic stents (MPSs), although the use of fully covered self-expandable metal stents (cSEMSs) is emerging. This study aims to compare the efficacy and safety of cSEMSs versus MPSs in these patients. METHODS: A single-center, open-label, randomized clinical trial was performed...
April 25, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28427741/management-of-biliary-anastomotic-strictures-after-liver-transplantation
#12
REVIEW
Aydin Seref Koksal, Ahmet Tarik Eminler, Erkan Parlak, Ahmet Gurakar
Biliary strictures constitute 40% to 60% of the biliary complications after liver transplantation. They are more common after living donor related liver transplantation (LDLT) than orthotopic liver transplantation (OLT). Balloon dilation followed by multiple plastic stent insertion leads to a mean resolution rate of 84% in the treatment of ASs after OLT. Endoscopic treatment of ASs after LDLT is more difficult because of the small size of the ASs, their multiple number and peripheral location. Balloon dilation followed by multiple plastic stent insertion had a mean resolution rate of 53%...
July 2017: Transplantation Reviews
https://www.readbyqxmd.com/read/28426684/long-term-results-after-transplantation-of-pediatric-liver-grafts-from-donation-after-circulatory-death-donors
#13
Rianne van Rijn, Pieter E R Hoogland, Frank Lehner, Ernest L W van Heurn, Robert J Porte
BACKGROUND: Liver grafts from donation after circulatory death (DCD) donors are increasingly accepted as an extension of the organ pool for transplantation. There is little data on the outcome of liver transplantation with DCD grafts from a pediatric donor. The objective of this study was to assess the outcome of liver transplantation with pediatric DCD grafts and to compare this with the outcome after transplantation of livers from pediatric donation after brain death (DBD) donors. METHOD: All transplantations performed with a liver from a pediatric donor (≤16 years) in the Netherlands between 2002 and 2015 were included...
2017: PloS One
https://www.readbyqxmd.com/read/28409358/added-value-of-gadoxetic-acid-enhanced-t1-weighted-magnetic-resonance-cholangiography-for-the-diagnosis-of-post-transplant-biliary-complications
#14
Sonja Kinner, Tilman B Schubert, Adnan Said, Joshua D Mezrich, Scott B Reeder
OBJECTIVES: Biliary complications after liver transplantation (LT) are common. This study aimed to ascertain the value of gadoxetic acid-enhanced T1-weighted (T1w) magnetic resonance cholangiography (MRC) to evaluate anastomotic strictures (AS), non-anastomotic strictures (NAS) and biliary casts (BC). METHODS: Sixty liver-transplanted patients with suspicion of biliary complications and T2w-MRCP and T1w-MRC followed by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) were analysed...
April 13, 2017: European Radiology
https://www.readbyqxmd.com/read/28394402/dual-hypothermic-oxygenated-machine-perfusion-in-liver-transplants-donated-after-circulatory-death
#15
R van Rijn, N Karimian, A P M Matton, L C Burlage, A C Westerkamp, A P van den Berg, R H J de Kleine, M T de Boer, T Lisman, R J Porte
BACKGROUND: Experimental studies have suggested that end-ischaemic dual hypothermic oxygenated machine perfusion (DHOPE) may restore hepatocellular energy status and reduce reperfusion injury in donation after circulatory death (DCD) liver grafts. The aim of this prospective case-control study was to assess the safety and feasibility of DHOPE in DCD liver transplantation. METHODS: In consecutive DCD liver transplantations, liver grafts were treated with end-ischaemic DHOPE...
June 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28331447/novel-biliary-reconstruction-techniques-during-liver-transplantation
#16
Ian C Carmody, John Romano, Humberto Bohorquez, Emily Bugeaud, David S Bruce, Ari J Cohen, John Seal, Trevor W Reichman, George E Loss
BACKGROUND: Biliary complications remain a significant problem following liver transplantation. Several surgical options can be used to deal with a significant size mismatch between the donor and recipient bile ducts during the biliary anastomosis. We compared biliary transposition to recipient biliary ductoplasty in cadaveric liver transplant. METHODS: A total of 33 reconstructions were performed from January 1, 2005 to December 31, 2013. In the biliary transposition group (n=23), 5 reconstructions were performed using an internal stent (5 or 8 French pediatric feeding tube), and 18 were performed without...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/28319567/treatment-of-biliary-stricture-after-live-donor-liver-transplantation-with-combined-metal-and-plastic-stent-%C3%A4-nsertion-a-feasibility-and-safety-study
#17
Erkan Parlak, Aydin Seref Koksal, Ahmet Tarik Eminler, Bilal Toka, Mustafa Ihsan Uslan
BACKGROUND: Fully covered-self expandable metal stents (Fc-SEMSs) have a challenging use in the treatment of anastomosis strictures (ASs) after live donor liver transplantation (LDLT) because they can occlude secondary branch biliary ducts when placed above the biliary bifurcation. In this study we evaluated the technical feasibility and safety of combining Fc-SEMSs with plastic stent(s) inserted to the secondary branch biliary ducts for the treatment of ASs after LDLT. METHODS: The study group included 22 patients (12 men, aged 51±11 years) with anastomotic biliary stricture after LDLT...
March 18, 2017: Transplantation
https://www.readbyqxmd.com/read/28302527/multiple-plastic-stents-versus-covered-metal-stent-for-treatment-of-anastomotic-biliary-strictures-after-liver-transplantation-a%C3%A2-prospective-randomized-multicenter-trial
#18
Andrea Oliver Tal, Fabian Finkelmeier, Natalie Filmann, Leena Kylänpää, Marianne Udd, Ilaria Parzanese, Paolo Cantù, Alexander Dechêne, Volker Penndorf, Andreas Schnitzbauer, Mireen Friedrich-Rust, Stefan Zeuzem, Jörg G Albert
BACKGROUND AND AIMS: Treatment of anastomotic biliary strictures (ABSs) after orthotopic liver transplantation by endoscopic insertion of multiple plastic stents (MPSs) is well established. The use of covered self-expandable metal stents (cSEMSs) for this indication is less investigated. METHODS: In an open-label, multicenter, randomized trial, patients with confirmed ABSs were randomly assigned 1:1 to receive either an MPS or a cSEMS. The primary endpoint was the number of endoscopic interventions until ABS resolution...
March 14, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28260480/living-donor-liver-transplant-follow-up-a-singlecenter-experience
#19
Syed Mudassir Laeeq, Farina M Hanif, Nasir Hassan Luck, Rajesh Kumar Mandhwani, Jawed Iqbal, Syed Haider Mehdi
OBJECTIVES: Liver transplant is a definite treatment of decompensated liver disease. Because of the shortage of livers from deceased donors, living-donor liver transplant is becoming more common. Here, we analyzed our clinical experience in the follow-up care of these patients. MATERIALS AND METHODS: Liver transplant recipients seen at the Sindh Institute of Urology and Transplantation (Karachi, Pakistan) were included in this analysis. Baseline characteristics and follow-up events were recorded...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28246547/salvage-therapy-using-self-expandable-metal-stents-for-recalcitrant-anastomotic-strictures-after-living-donor-liver-transplantation
#20
Sung Ill Jang, Se Yong Sung, Hyunsung Park, Kwang-Hun Lee, Seung-Moon Joo, Dong Ki Lee
BACKGROUND: Recently, there has been an increase in clinical success rates using nonsurgical methods to resolve anastomotic biliary strictures (ABSs) that develop after liver transplantation (LT). However, some strictures are particularly refractory and cannot be completely resolved by an endoscopic or percutaneous procedure. Consequently, the aim of this study was to examine the feasibility and efficacy of using a newly designed fully covered self-expandable metal stent (FCSEMS) to resolve refractory ABS...
March 2017: Therapeutic Advances in Gastroenterology
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