Nonanastomotic biliary strictures after liver transplantation, part 1: Radiological features and risk factors for early vs. late presentation
Nonanastomotic biliary strictures after liver transplantation, part 1: Radiological features and risk factors for early vs. late presentation
复制标题
DOI：
10.1002/lt.21166
复制
发表时间：
2007-05-01
影响因子：
4.6
通讯作者：
Porte, Robert J.
中科院分区：
文献类型：
--
作者：
Buis, Carlijn I.;Verdonk, Robert C.;Porte, Robert J.
非吻合性胆管狭窄是原位肝移植术后的一种严重并发症。确切的发病机制尚不清楚。本研究的目的是确定奥尔特后NAS发展的危险因素。共研究了487例成人肝移植，中位随访时间为7.9年。对胆道系统的所有影像学研究进行了审查。术后第10-14天常规进行胆管造影，之后根据需要进行。NAS首次出现时的定位分为胆道系统的4个解剖区。NAS的严重程度半定量为轻度、中度或重度。分析供者、受者和手术特征和变量，以确定NAS的危险因素。81例（16.6%）肝脏发生NAS。37例（7.3%）被评为中度至重度。在85%的病例中，NAS的解剖定位在胆总管分叉周围或下方。观察到奥尔特和首次出现NAS之间的时间间隔存在很大差异（中位数4.1个月;范围0.3-155个月）。奥尔特早期（1年）出现NAS（分别为694 min和490 min，P = 0.01; 57 min和53 min，P < 0.05），早期NAS多位于中央胆管。奥尔特后1年以上出现的NAS多发生于肝周，且与免疫因素如原发性硬化性胆管炎有关，是奥尔特的指征（24% vs.45%，P < 0.05）。通过根据移植后出现的时间来分离NAS病例，我们能够确定风险因素的差异，表明不同的致病机制取决于最初出现的时间。
Nonanastomotic biliary strictures (NAS) are a serious complication after orthotopic liver transplantation (OLT). The exact pathogenesis is unclear. Purpose of this study was to identify risk factors for the development of NAS after OLT. A total of 487 adult liver transplants with a median follow-up of 7.9 years were studied. All imaging studies of the biliary tree were reviewed. Cholangiography was routinely performed between postoperative days 10-14 and later on demand. Localization of NAS at first presentation was categorized into 4 anatomical zones of the biliary tree. Severity of NAS was semiquantified as mild, moderate, or severe. Donor, recipient, and surgical characteristics and variables were analyzed to identify risk factors for NAS. NAS developed in 81 livers (16.6%). Thirty-seven (7.3%) were graded as moderate to severe. In 85% of the cases, anatomical localization of NAS was around or below the bifurcation of the common bile duct. A large variation was observed in the time interval between OLT and first presentation of NAS (median 4.1 months; range 0.3-155 months). NAS presenting early ( 1 year) after OLT (694 minutes vs. 490 minutes, P = 0.01, and 57 minutes vs. 53 minutes, P < 0.05, respectively), and early NAS were more frequently located in the central bile ducts. NAS presenting late (> 1 year) after OLT were found more frequently in the periphery of the liver and were more frequently associated with immunological factors, such as primary sclerosing cholangitis, as the indication for OLT (24% vs. 45%, P < 0.05). By separating cases of NAS on the basis of the time of presentation after transplantation, we were able to identify differences in risk factors, indicating different pathogenic mechanisms depending on the time of initial presentation.