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anastomotic stricture liver transplant

Ana Rita Alves, Dário Gomes, Emanuel Furtado, Luís Tomé
Background and Aims: Biliary tract complications following liver transplant remain an important source of morbidity and mortality. Endoscopic retrograde cholangiopancreatography (ERCP) has become a common therapeutic option before other invasive procedures. The aim of this study was to evaluate ERCP efficacy in managing this type of complications. Methods: Retrospective study of all patients who underwent therapeutic ERCP due to post-liver transplant biliary complications between September 2005 and September 2015, at a deceased donor liver transplantation centre...
January 2018: GE Portuguese Journal of Gastroenterology
Kristopher P Croome, Amit K Mathur, David D Lee, Adyr A Moss, Charles B Rosen, Julie K Heimbach, C Burcin Taner
INTRODUCTION: As the population in the United States continues to age, an increase in the number of potential DCD donors with advanced chronological age can be expected. The aim of this study was to analyze a multi-institutional experience in liver transplantation using DCD donor age ≥50 years. METHODS: All DCD LT performed at Mayo Clinic Florida, Mayo Clinic Rochester and Mayo Clinic Arizona from 2002-2016 were included. Recipients of DCD LT were divided into 2 groups: those with donor age ≥50 years(N=155) and those with donor age <50 years(N=316)...
January 31, 2018: Transplantation
Michael Senter-Zapata, Adeel S Khan, Tanvi Subramanian, Neeta Vachharajani, Leigh Anne Dageforde, Jason R Wellen, Surendra Shenoy, Maria B Majella Doyle, William C Chapman
BACKGROUND: Biliary complications (BC) effect upto to 34% of liver transplant (LT) recipients and are a major source of morbidity and cost. This is a 13-year review of BC after LT at a tertiary care center. STUDY DESIGN: Single center retrospective review of prospective database to assess BC in adult (≥18yrs) LT recipients over a 13 period (2002-2014). BC were divided into three sub-groups: leak alone(L), stricture alone(S), and both leak and strictures(LS). Controls (no BC) were used for comparison...
January 19, 2018: Journal of the American College of Surgeons
Elizabeth Ann Forrest, Janske Reiling, Geraldine Lipka, Jonathan Fawcett
AIM: To identify risk factors associated with the formation of biliary strictures post liver transplantation over a period of 10-year in Queensland. METHODS: Data on liver donors and recipients in Queensland between 2005 and 2014 was obtained from an electronic patient data system. In addition, intra-operative and post-operative characteristics were collected and a logistical regression analysis was performed to evaluate their association with the development of biliary strictures...
December 24, 2017: World Journal of Transplantation
Jing Zhang, Feng-Gang Ren, Peng Liu, Hong-Ke Zhang, Hao-Yang Zhu, Zhe Feng, Xu-Feng Zhang, Bo Wang, Xue-Ming Liu, Xiao-Gang Zhang, Rong-Qian Wu, Yi Lv
AIM: To explore the possible relationship between fecal microbial communities and non-anastomotic stricture (NAS) after liver transplantation (LT). METHODS: A total of 30 subjects including 10 patients with NAS, 10 patients with no complications after LT, and 10 non-LT healthy individuals were enrolled. Fecal microbial communities were assessed by the 16S rRNA gene sequencing technology. RESULTS: Different from the uncomplicated and healthy groups, unbalanced fecal bacterium ratio existed in patients with NAS after LT...
December 14, 2017: World Journal of Gastroenterology: WJG
Anne Claire den Dulk, Xiaolei Shi, Cornelia J Verhoeven, Jeroen Dubbeld, Frans H J Claas, Ron Wolterbeek, Simone H Brand-Schaaf, Hein W Verspaget, Arantza Fariña Sarasqueta, Luc J W van der Laan, Herold J Metselaar, Bart van Hoek, Jaap Kwekkeboom, Dave L Roelen
Donor-specific alloantibodies (DSA) have been associated with rejection and shorter graft survival after orthotopic liver transplantation (OLT). We examined the role of DSA in nonanastomotic biliary strictures (NAS) after OLT. Patients receiving first OLT who developed NAS (n = 68) and a control group without NAS (n = 83), with pre-OLT and 12 months post-OLT serum samples, were included. DSA were specified using the Luminex single antigen test. Risk factors for NAS and graft survival were analyzed. The presence of preformed DSA was not significantly different between patients with NAS and controls (P = ...
February 2018: Clinical Transplantation
Samir Zeair, Filip Butkiewicz, Jacek Butkiewicz, Robert Stasiuk
BACKGROUND Standard methods for endoscopic retrograde cholangiopancreatography (ERCP) management of anastomotic strictures (AS) after OLT includes repeated balloon dilation of the stricture with subsequent insertion of a plastic biliary stent (PBS). In post-OLT patients not responding to standard endoscopic treatment, the placement of fully covered self-expanding metal stents (FCSEMS) is a valid alternative to surgical treatment. The aim of this study was to compare the results of new FCSEMS implantation with the standard ERCP stricture management protocol and with conventional FCSEMS insertion...
December 1, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Narendra Singh Choudhary, Neeraj Saraf, Sanjiv Saigal, Dheeraj Gautam, Amit Rastogi, Sanjay Goja, Prashant Bhangui, Thiagrajan Srinivasan, Sanjay Kumar Yadav, Arvinder Soin
BACKGROUND AND AIMS: Chronic rejection (CR) is an uncommon but important cause of graft dysfunction, leading to graft loss and often requires re-transplantation. This study evaluates the incidence and outcome of patients with CR at a large living donor liver transplant (LDLT) centre. METHODS: Data of patients with CR was retrospectively analyzed in 1232 adult (age >18 years) LDLT on Tacrolimus (mainly) based immunosuppression. Sirolimus/Everolimus (mTOR inhibitors) were added to baseline immunosuppression as rescue therapy in patients with CR...
November 21, 2017: Clinical Transplantation
Nicolas Meurisse, Jacques Pirenne, Diethard Monbaliu
INTRODUCTION: Non-anastomotic biliary strictures (NAS) represent a major cause of morbidity, graft loss, and mortality after liver transplantation (LTx). NAS can result from an ischemic/immune-mediated injury, or from the cytotoxic effect that bile salts have on the biliary mucosa under hypothermic conditions. For this reason it is crucial to flush the bile duct at the time of procurement. PRESENTATION OF CASE: We report a case of an imported liver with an accidentally ligated and subsequently completely unflushed common bile duct...
2017: International Journal of Surgery Case Reports
Filippo Landi, Nicola de'Angelis, Ailton Sepulveda, Aleix Martínez-Pérez, Iradj Sobhani, Alexis Laurent, Olivier Soubrane
Anastomotic biliary strictures (ABSs) occur in up to 15% of patients after liver transplantation (LT). The aim of this study was to compare the efficacy and safety of self-expandable metal stents (SEMS) versus multiple plastic stents (MPS). Databases were searched through April 2017. The outcome measures were technical success, stricture resolution, recurrence and complications. We synthesized the findings descriptively and performed a meta-analysis. Three randomized controlled trials and one retrospective cohort study were identified, including 179 MPS and 119 SEMS patients...
February 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Sun-Chuan Dai, David Goldberg, Amol Agarwal, Gene K Ma, Clinton Yam, Nuzhat A Ahmad, Gregory G Ginsberg, David L Jaffe, Michael L Kochman, Kim M Olthoff, Vinay Chandrasekhara
INTRODUCTION: Orthotopic liver transplantation anastomotic biliary strictures (OLT ABS) are managed with endoscopic biliary stent therapy but the recurrence rate is substantial. Our aims were to retrospectively determine the recurrence rates of OLT ABS after initial successful stent therapy, characterize the management of recurrences and identify associated variables. MATERIALS AND METHODS: Clinical data from 943 patients receiving non-living donor OLT at our institution from 2005-2012 were reviewed, and 123 OLT ABS patients receiving stent therapy were identified...
October 16, 2017: Annals of Hepatology
Dayse Pereira da Silva Aparício, José Pinhata Otoch, Edna Frasson de Souza Montero, Muhammad Ali Khan, Everson Luiz de Almeida Artifon
The most common biliary complication after liver transplantation is anastomotic stricture (AS) and it can occur isolated or in combination with other complications. Liver graft from a cadaveric donor or a living donor has an influence on the incidence of biliary strictures as well as on the response to endoscopic treatment. Endoscopic treatment using balloon dilation and insertion of biliary stents by endoscopic retrograde cholangiopancreatography (ERCP) is the initial approach to these complications. AIM: The aim of this article is to compare different endoscopic techniques to treat post-liver transplantation biliary strictures...
October 2017: United European Gastroenterology Journal
Mohamed D Sarhan, Ayman M A Osman, Mahmoud Aly Mohamed, Omar Abdelaziz, Dalia K Serour, Doaa A Mansour, Sherif Mogawer, Ayman S Helmy, Mostafa A El-Shazli, Adel A Hosny
OBJECTIVES: Biliary complications are common after living-donor liver transplant. This retrospective study reviewed our experience with biliary complications in recipients of living-donor liver transplant. MATERIALS AND METHODS: Over our 9-year study period, 120 patients underwent living-donor liver transplant. Patients were divided into 2 groups, with group A having biliary complications and group B without biliary complications. Both groups were compared, and different treatment modalities for biliary complications were evaluated...
December 2017: Experimental and Clinical Transplantation
Hebah M Musalem, Yazan N Honjol, Lin M Tuleimat, Saleh I Al Abbad, Fahad I Alsohaibani
BACKGROUND Elizabethkingia meningoseptica (E. meningoseptica) is an aerobic Gram-negative bacillus known to thrive in moist environments, and is now recognized as a hospital-acquired infection, being found to contaminate hospital equipment, respiratory apparatus, hospital solutions, water, and drainage systems. Nosocomial infection with E. meningoseptica occurs in immunocompromised patients, requires specialized identification methods, and is resistant to conventional antibiotics. We report a case of E. meningoseptica infection arising from a percutaneous transhepatic biliary drainage (PTBD) tube...
September 21, 2017: American Journal of Case Reports
Fernanda P Martins, Angelo P Ferrari
No abstract text is available yet for this article.
November 2017: Endoscopy
Jacob A Mark, Cara L Mack, Ahmed I Marwan, Robert E Kramer
OBJECTIVE: Endoscopic retrograde cholangiopancreatography (ERCP) is used to manage biliary pathology in pediatric patients. Plastic biliary stents have been utilized in this population for obstructive lesions and bile leaks, however they are sometimes not effective due to migration, occlusion, or ineffective sealing. Fully covered self-expanding metal stents (FCSEMS) have larger diameters making them more suitable for some situations. However, their use in pediatrics has not been defined...
August 23, 2017: Journal of Pediatric Gastroenterology and Nutrition
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 healthcare costs, and decreasing reimbursement for procedures mandate maximal efficiency in performing ERCP...
July 27, 2017: Gastrointestinal Endoscopy
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
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...
November 2017: Journal of Hepatology
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
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