Intrahepatic biliary strictures without hepatic artery thrombosis after liver transplantation: An analysis of 1,113 liver transplantations at a single center
Intrahepatic biliary strictures without hepatic artery thrombosis after liver transplantation: An analysis of 1,113 liver transplantations at a single center
复制标题
DOI：
10.1097/01.tp.0000152800.19986.9e
复制
发表时间：
2005-02-27
期刊：
影响因子：
6.2
通讯作者：
Madariaga, JR
中科院分区：
文献类型：
--
作者：
Nakamura, N;Nishida, S;Madariaga, JR
背景。肝内胆道狭窄（IHBS）无肝动脉血栓形成（HAT）是一种严重的并发症，已知会增加肝移植术后移植失败的风险。本文描述了发病率、危险因素、临床表现、治疗和结果。1994年至2002年间，974名成年患者进行了1113例肝移植手术。回顾性分析资料的发生率、危险因素、临床表现（狭窄类型）、处理（放射学、外科处理）和结果。16例（1.4%）移植物无HAT的IHBS。具体的风险因素没有从捐赠者或接受者中确定出来。然而，非心脏跳动供者（n=1）和心脏骤停供者（n=2）怀疑供者有缺血因素。确定了三种IHBS类型：(1)弥漫性型（n=7），(2)双侧近端型（n=7）和(3)单侧型（n=2）。放疗总成功率为31.3%（5/16）。在没有改善的I I患者中，6例死亡：弥漫性（3/7,42.9%），双侧（3/7,42.9%）和单侧（0/2,0%）。3例患者进行了再移植，2例患者正在等待再移植。大多数IHBS为弥漫性或双侧（14/16,87.5%），移植物失败率高（10/14,71.4%）。IHBS组移植物总存活率低于无lHBS组（P=0.025）。大多数无HAT的IHBS为弥漫性或双侧近端型。弥漫性或双侧近端型患者放射治疗成功率低，早期再移植可获益。
Background. Intrahepatic biliary strictures (IHBS) without hepatic artery thrombosis (HAT) is a serious complication and known to increase the risk of graft failure after liver transplantation. This manuscript describes the incidence, risk factors, clinical pictures, management, and outcomes.Methods. Between 1994 and 2002, 1,113 liver transplantations were performed in 974 adult patients. Data was retrospectively analyzed in terms of incidence, risk factors, clinical pictures (type of strictures), management (radiologic, surgical management), and outcomes.Results. Sixteen (1.4%) grafts had IHBS without HAT. Specific risk factors were not identified from donors or recipients. However, ischemic factors from the donors were suspected from non-heart-beating donors (n=1) and cardiac-arrest donors (n=2). Three types of IHBS were identified: (1) diffuse type (n=7), (2) bilateral proximal type (n=7), and (3) unilateral type (n=2). Overall success rate of radiologic interventions was 31.3% (5/16). Of the I I patients who did not improve, 6 died: diffuse type (3/7, 42.9%), bilateral type (3/7, 42.9%), and unilateral (0/2, 0%). Three patients had retransplantation, and two patients are waiting retransplantation. The majority of the IHBS were diffuse or bilateral (14/16, 87.5%), and rate of the graft failure was high (10/14, 71.4 %). Overall graft survival of IHBS was lower than that without lHBS (P=0.025).Conclusions. The majority of the IHBS without HAT were of a diffuse or bilateral proximal type. Patients with diffuse or bilateral proximal type have a low success rate from radiologic intervention and may benefit from early retransplantation.