medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2015, Number 3

<< Back Next >>

Ann Hepatol 2015; 14 (3)

Risk factors for early repeat ERCP in liver transplantation patients with anastomotic biliary stricture

Tabibian JH, Girotra M, Hsin-Chieh Y, Singh VK , Okolo III PI, Cameron AM, Gurakar A

Language: English
References: 28
Page: 340-347
PDF size: 104.90 Kb.


ABSTRACT

Introduction. Anastomotic biliary strictures (ABS) are a significant clinical problem associated with decreased survival post-liver transplantation (LT). Contributing to the morbidity of ABS is the need for early (i.e. emergent or unplanned) repeat endoscopic retrograde cholangiopancreatographies (ER-ERCPs). Our aim was to determine clinical, operative, and endoscopic predictors of ER-ERCP in patients with ABS. Material and methods. Medical records of 559 patients who underwent LT at our institution from 2000-2012 were retrospectively reviewed for pertinent data. The primary endpoint was need for ER-ERCP. Seventeen potential predictors of ER-ERCP were assessed in bivariate analyses, and those with p ‹ 0.20 were included in multivariate regression models. Results. Fifty-four LT patients developed ABS and underwent a total of 200 ERCPs, of which 40 met criteria for ER-ERCP. Predictors of ER-ERCP in bivariate analyses included balloon dilation within 3 months post-LT and donation after cardiac death (both p ‹ 0.05). Balloon dilation within 3 months post-LT was also associated with shorter ER-ERCP-free survival (p = 0.02). Moreover, a significantly higher proportion (67%) of patients who underwent balloon dilation within 3 months post-LT subsequent experienced ≥ 1 ER-ERCP (p = 0.03), and those who experienced ≥ 1 ER-ERCP had lower stricture resolution rates at the end of endoscopic therapy compared to those who did not (79 vs. 97%, p = 0.02). In multivariate analyses, balloon dilation within 3 months post-LT was the strongest predictor of ER-ERCP (OR 3.8, 95% CI 1.7-8.6, p = 0.001). Conclusions. Balloon dilation of ABS within 3 months post-LT is associated with an increased risk of ER-ERCP, which itself is associated with lower ABS resolution rates. Prospective studies are needed to confirm these findings and their implications for endoscopic management and follow-up of post-LT ABS.


REFERENCES

  1. Graziadei IW, Schwaighofer H, Koch R, Nachbaur K, Koenigsrainer A, Margreiter R, Vogel W. Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation. Liver Transpl 2006; 12: 718-25.

  2. Tabibian JH, Asham EH, Han S, Saab S, Tong MJ, Goldstein L, Busuttil RW, et al. Endoscopic treatment of postorthotopic liver transplantation anastomotic biliary strictures with maximal stent therapy (with video). Gastrointest Endosc 2010; 71: 505-12.

  3. Maheshwari A, Maley W, Li Z, Thuluvath PJ. Biliary complications and outcomes of liver transplantation from donors after cardiac death. Liver Transpl 2007; 13: 1645-53.

  4. Sundaram V, Jones DT, Shah NH, de Vera ME, Fontes P, Marsh JW, Humar A, et al. Posttransplant biliary complications in the pre- and post-model for end-stage liver disease era. Liver Transpl 2011; 17: 428-35.

  5. Sherman S, Jamidar P, Shaked A, Kendall BJ, Goldstein LI, Busuttil RW. Biliary tract complications after orthotopic liver transplantation. Endoscopic approach to diagnosis and therapy. Transplantation 1995; 60: 467-70.

  6. Azeem N, Tabibian JH, Baron TH, Orhurhu V, Rosen CB, Petersen BT, Gostout CJ, et al. Use of a single-balloon enteroscope compared with variable-stiffness colonoscopes for endoscopic retrograde cholangiography in liver transplant patients with Roux-en-Y biliary anastomosis. Gastrointest Endosc 2013; 77: 568-77.

  7. Catalano MF, Van Dam J, Sivak MV, Jr. Endoscopic retrograde cholangiopancreatography in the orthotopic liver transplant patient. Endoscopy 1995; 27: 584-8.

  8. Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, Qureshi W, et al. ASGE guideline: the role of ERCPP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 2005; 62: 1-8.

  9. Enestvedt CK, Malik S, Reese PP, Maskin A, Yoo PS, Fayek SA, Abt P, et al. Biliary complications adversely affect patient and graft survival after liver retransplantation. Liver Transpl 2013; 19: 965-72.

  10. Pasha SF, Harrison ME, Das A, Nguyen CC, Vargas HE, Balan V, Byrne TJ, et al. Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: outcomes after maximal stent therapy. Gastrointest Endosc 2007; 66: 44-51.

  11. Morelli G, Fazel A, Judah J, Pan JJ, Forsmark C, Draganov P. Rapid-sequence endoscopic management of posttransplant anastomotic biliary strictures. Gastrointest Endosc 2008; 67: 879-85.

  12. Buis CI, Verdonk RC, Van der Jagt EJ, van der Hilst CS, Slooff MJ, Haagsma EB, Porte RJ. Nonanastomotic biliary strictures after liver transplantation, part 1: Radiological features and risk factors for early vs. late presentation. Liver Transpl 2007; 13: 708-18.

  13. Verdonk RC, Buis CI, van der Jagt EJ, Gouw AS, Limburg AJ, Slooff MJ, Kleibeuker JH, et al. Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression. Liver Transpl 2007; 13: 725-32.

  14. Rerknimitr R, Sherman S, Fogel EL, Kalayci C, Lumeng L, Chalasani N, Kwo P, et al. Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy. Gastrointest Endosc 2002; 55: 224-31.

  15. Tabibian JH, Asham EH, Goldstein L, Han SH, Saab S, Tong MJ, Busuttil RW, et al. Endoscopic treatment with multiple stents for post-liver-transplantation nonanastomotic biliary strictures. Gastrointest Endosc 2009; 69: 1236-43.

  16. Costamagna G, Tringali A, Mutignani M, Perri V, Spada C, Pandolfi M, Galasso D. Endotherapy of postoperative biliary strictures with multiple stents: results after more than 10 years of follow-up. Gastrointest Endosc 2010; 72: 551-7.

  17. Tabibian JH, Yeh HC, Singh VK, Cengiz-Seval G, Cameron AM, Gurakar A. Sirolimus may be associated with early recurrence of biliary obstruction in liver transplant patients undergoing endoscopic stenting of biliary strictures. Ann Hepatol 2011; 10: 270-6.

  18. Tabibian JH, Girotra M, Yeh HC, Segev DL, Gulsen MT, Cengiz-Seval G, Singh VK, et al. Sirolimus based immunosuppression is associated with need for early repeat therapeutic ERCPP in liver transplant patients with anastomotic biliary stricture. Ann Hepatol 2013; 12: 563-9.

  19. Barshes NR, Lee TC, Balkrishnan R, Karpen SJ, Carter BA, Goss JA. Orthotopic liver transplantation for biliary atresia: the U.S. experience. Liver Transpl 2005; 11: 1193-200.

  20. Musat AI, Pigott CM, Ellis TM, Agni RM, Leverson GE, Powell AJ, Richards KR, et al. Pretransplant donor-specific antiHLA antibodies as predictors of early allograft rejection in ABO-compatible liver transplantation. Liver Transpl 2013; 19: 1132-41.

  21. Wagener G, Raffel B, Young AT, Minhaz M, Emond J. Predicting early allograft failure and mortality after liver transplantation: the role of the postoperative model for end-stage liver disease score. Liver Transpl 2013; 19: 534-42.

  22. Ryu CH, Lee SK. Biliary strictures after liver transplantation. Gut Liver 2011; 5: 133-42.

  23. Gurakar A, Wright H, Camci C, Jaboour N. The application of SpyScope(R) technology in evaluation of pre and post liver transplant biliary problems. Turk J Gastroenterol 2010; 21: 428-32.

  24. Chen LP, Zhang QH, Chen G, Qian YY, Shi BY, Dong JH. Rapamycin inhibits cholangiocyte regeneration by blocking interleukin-6-induced activation of signal transducer and activator of transcription 3 after liver transplantation. Liver Transpl 2010; 16: 204-14.

  25. Welling TH, Heidt DG, Englesbe MJ, Magee JC, Sung RS, Campbell DA, et al. Biliary complications following liver transplantation in the model for end-stage liver disease era: effect of donor, recipient, and technical factors. Liver Transpl 2008; 14: 73-80.

  26. Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation: past, present and preventive strategies. Liver Transpl 2008; 14: 759-69.

  27. Tabibian JH, Masyuk AI, Masyuk TV, O’Hara SP, LaRusso NF. Physiology of cholangiocytes. Compr Physiol 2013; 3: 541-65.

  28. Chapter “Liver and Bile” published in Reference Module in Biomedical Research, 3rd Edition, http://dx.doi.org/ 10.1016/B978-0-12-801238-3.00047-7




2020     |     www.medigraphic.com