Risk factors for and clinical course of non-anastomotic biliary strictures after liver transplantation
Risk factors for and clinical course of non-anastomotic biliary strictures after liver transplantation
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DOI：
10.1034/j.1600-6143.2003.00165.x
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发表时间：
2003-07-01
影响因子：
8.8
通讯作者：
Charlton, MR
中科院分区：
文献类型：
--
作者：
Guichelaar, MMJ;Benson, JT;Charlton, MR
非吻合性胆道狭窄(NAS)是肝移植的主要并发症。我们前瞻性地确定了NAS形成后发展对治疗的反应性的时间和临床结果。此外，还对受体、供体和临床变量与NAS形成的关系进行了广泛的分析。以前瞻性的、基于方案的方式对749名连续患者进行了研究。72例(9.6%)患者在移植后平均23.6+/-34.2周发生NAS。非吻合口胆管狭窄形成只有6%的患者得到解决。虽然患者的存活率没有受到影响，但发生NAS的受者的再次移植和移植物损失率明显更高。与以前的报告不同，移植前诊断出的丙型肝炎病毒与低频率的NAS形成有关。NAS的发生率与移植前诊断的PSC和自身免疫性肝炎独立相关。肝动脉血栓形成、冷、热缺血时间延长也是NAS形成的独立危险因素。我们得出结论，NAS在初次肝移植受者中的发病率与10%相似。移植前诊断的自身免疫性肝炎已被确认为NAS形成的一个新的独立危险因素。NAS的发展会显著降低移植物的存活率，但不会影响患者的存活率。
Non-anastomotic biliary stricture (NAS) formation is : major complication of liver transplantation. We prospectively determined the time to development of responsiveness to treatment, and clinical outcomes following NAS formation. In addition, an extensive analysis of the association of recipient, donor, and clinical variables with NAS formation was performed. A total of 749 consecutive patients was studied in a prospective, protocol-based fashion. Seventy-two patients (9.6%) developed NAS at a mean of 23.6 +/- 34.2 weeks post-transplantation. Non-anastomotic biliary stricture formation resolved in only 6% of affected patients. Although patient survival was not affected, retransplantation and graft loss rates were significantly greater in recipients who developed NAS. In contrast to previous reports, a pretransplant diagnosis of HCV was associated with a low frequency of NAS formation. The incidence of NAS was independently associated with pretransplant diagnoses of PSC and autoimmune hepatitis. Hepatic artery thrombosis, and prolonged warm and cold ischemia times were also independent risk factors for NAS formation. We conclude that NAS developed in similar to10% of primary liver transplant recipients. A pretransplant diagnosis of autoimmune hepatitis has been identified as a novel independent risk factor for NAS formation. Development of NAS significantly attenuates graft but not patient survival.