Ischemic Complications after Liver Transplantation

2018 ◽  
Vol 02 (03) ◽  
pp. 244-248
Author(s):  
Martin Montenovo ◽  
Christopher Ingraham
Keyword(s):  
Liver Transplantation ◽  
Patient Survival ◽  
Vascular Complications ◽  
Biliary Tree ◽  
Biliary Complications ◽  
Surgical Anastomosis ◽  
Biliary Leak ◽  
The Past ◽  
Ischemic Complications ◽  
Transplantation Complications

AbstractDespite major advances in the field of liver transplantation over the past few decades with both increased graft and patient survival, biliary complications still occur in many patients after liver transplantation. Complications can range from a biliary leak or biloma to strictures most commonly involving the surgical anastomosis, or elsewhere in the biliary tree. Etiologies of these complications include surgical technique, rejection, complications secondary to infection, and vascular complications causing ischemia of the bile ducts. Biliary complications, particularly biliary ischemia, can cause significant morbidity to the patient, and may require multiple endoscopic, endovascular, or percutaneous therapies for successful treatment, or even retransplantation in severe cases. This review will provide an overview of common biliary complications with a focus on biliary ischemia.

The impact of hepatitis C virus infection on early post-liver transplantation complications and early graft function in a single low-volume liver transplant center

2015 ◽  
Vol 22 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Arida Buivydienė ◽  
Viktorija Basytė ◽  
Laura Mašalaitė ◽  
Danguolė Stanislovaitytė ◽  
Jurgita Adomavičiūtė ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Graft Function ◽  
Vascular Complications ◽  
Hcv Infection ◽  
End Stage Liver Disease ◽  
Transplant Center ◽  
Early Graft ◽  
Transplantation Complications ◽  
End Stage ◽  
The Impact

Background. End-stage liver disease associated with hepatitis C virus (HCV) infection has become one of the leading indications for liver transplantation. The effect of HCV infection on patients and long-term graft survival after orthotopic liver transplantation is well known. The aim of this study was to evaluate the impact of HCV infection on early post-liver transplantation complications and early graft function. Materials and methods. Between July 2005 and February 2015 60 cadaveric orthotopic liver transplantations were performed in 58 adult patients at the Vilnius University Hospital Santariškių Clinics. We retrospectively reviewed our low-volume liver transplant center experience. To evaluate the changes that occurred in HCV-positive and HCV-negative transplant recipients, the study population was divided into two groups according to their HCV status. Statistical analysis was performed using the Microsoft Excel and SPSS 20.0 program. Group differences and data reliability were determined by the Student’s t-test. Results. For 21 patients (35%) the indication for liver transplantation was end-stage liver disease due to HCV infection and for 39 patients (65%) there was another (non-HCV infection) indication. Overall, 29 patients (48%) have developed early biliary and/or vascular complications after transplantation: vascular complications were observed in 17 patients (28%) and biliary complications were observed in 12 patients (20%). Early graft function was good or fair in 52 patients (87%), primary dysfunction was observed in 8 (13%) patients. Conclusions. The incidence of early post-transplant complications and early graft dysfunction had no statistically significant difference according to the patient’s HCV status.

Hepatobiliary Scintigraphy to Evaluate Biliary Complications of Pediatric Liver Transplantation: An Account of an Experience

2020 ◽  
Author(s):  
Claudia Gutierrez-Villamil ◽  
Camila Velez-Gutierrez ◽  
Sinay Arevalo-Leal ◽  
Jairo Rivera-Baquero ◽  
Víctor Marín-Oyaga
Keyword(s):  
Liver Transplantation ◽  
Pediatric Patients ◽  
Clinical Decision Making ◽  
Expectant Management ◽  
Clinical Decision ◽  
Biliary Complications ◽  
Hepatobiliary Scintigraphy ◽  
Transplant Patients ◽  
Course Of Action ◽  
Transplantation Complications

Abstract Introduction Hepatobiliary scintigraphy (HS) is a noninvasive imaging technique whose use in the follow-up of liver transplantation has not been duly documented. The main objective of this study is to describe the experience of using this technique to detect biliary complications in pediatric patients following liver transplantation. Materials and Methods A retrospective, observational, and descriptive study involving 86 pediatric patients who had undergone liver transplantation between 2013 and 2018. Of the 86, 31 had undergone at least one HS during their postoperative period. Results A total of 45 studies were performed on 31 patients (36% of the patients undergoing transplantation during that time period). Patient ages ranged from 5 to 204 months (mean = 50 months). A total of 22 transplants (71%) were from living donors and 9 (29%) were from cadaveric donors. Of the 45 studies, 22 were positive for biliary complications, and all of them had an impact on clinical decision-making. The remaining 23 studies were negative. Of these 23, 19 continued under medical treatment and the other four underwent an additional intervention with positive surgical outcomes in all cases. All scintigraphy studies revealed hepatocellular dysfunction and cholestasis. Conclusion The HS is a useful, noninvasive, and diagnostic procedure for the early diagnosis of biliary complications that may impact the evolution of disease in liver transplant patients. It allows the treating physician to make a more informed decision regarding expectant management, surgical management, or a less invasive course of action for transplantation complications.

Complications of Hepatocellular Carcinoma patients post living Donor Liver Transplantation

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ashraf Mahmoud El-Sayed ◽  
Yasmine Mahmoud Massoud ◽  
Ayat Abdallah Abd-Elkalik
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Hepatitis C ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Immunosuppressive Treatment ◽  
Vascular Complications ◽  
Biliary Complications ◽  
Donor Liver ◽  
Donor Liver Transplantation

Abstract Background Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, accounting for about 1 million related deaths annually. An estimated 372, 000 new cases of hepatocellular carcinoma (HCC) are diagnosed each year, constituting 4.6% of all new human cancers. Objectives The aim of our study was to study the complications of Hepatocellular Carcinoma patients post living Donor Liver Transplantation at Ain Shams Center for Organ Transplantation. Patients and methods The study population underwent Living donor liver Transplanation due to hepatitis C virus related hepatocellular carcinoma during the period from January 2008 to 2019.A total number of 114 patients underwent LDLT due to HCV related hepatocellular carcinoma.Fourteen patients(12.2%) were excluded because of the intraoperative death or postoperative early death, 7 patients(6%) were excluded because of overlapping etiologies with hepatitis C (HBV,autoimmune hepatitis,BCS,…etc) and 11 patients (9.6%) were excluded due to their age.Eighty two patients fulfilling the inclusion criteria for enrollment were recruited in the study. Results The most common complications were (45.1%) neuropsychiatric side effects induced by immunosuppressive treatment, malignancy, hypertension, renal impairment, stroke, small for size disease…etc. Biliary complications (34.1%) as well as sepsis (34.1%) were the second common complications then rejection (18.3%), recurrence (12.2%), death (11%) and vascular complications (10%). Conclusion There was no statistical significance for those within or out side the Milan criteria or UCSF criteria and its impact on the occurrence of graft rejection, sepsis, vascular complications, death, HCC recurrence and biliary complications post-transplant.

The Outcome of Liver Transplantation in Patients With Hepatocellular Carcinoma in the United States Between 1988 and 2001: 5-Year Survival Has Improved Significantly With Time

2003 ◽  
Vol 21 (23) ◽  
pp. 4329-4335 ◽  
Author(s):  
Hwan Y. Yoo ◽  
Cary H. Patt ◽  
Jean-Francois Geschwind ◽  
Paul J. Thuluvath
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Patient Selection ◽  
Patient Survival ◽  
The United States ◽  
Control Group ◽  
Cox Regression Analysis ◽  
The Past ◽  
Kaplan Meier ◽  
Improvement In Survival

Purpose: We hypothesized that the outcome of liver transplantation in patients with hepatocellular carcinoma (HCC) has improved over the past decade because of the application of published criteria for patient selection. In this study, we compared the outcome of liver transplantation in patients with and without HCC at different time periods using the United Network for Organ Sharing data. Patients and Methods: We excluded children, patients with multiple organ transplantation or retransplantation, and those with incomplete survival data. The study period was arbitrarily divided into three time intervals: 1987 to 1991, 1992 to 1996, and 1997 to 2001. Results: During the study period, 985 patients with HCC (HCC group), and 33,339 without HCC underwent liver transplantation (control group). Kaplan-Meier patient and graft survivals were significantly lower for the HCC group compared with the control group. Cox regression analysis (after adjusting for other confounding variables) confirmed a lower patient survival in the HCC group (1-year survival, 77.0% v 86.7%; hazard ratio [HR], 1.7; 95% CI, 1.5 to 2.0; P < .0001) compared with the control group (5-year survival, 48.2% v 74.7%; HR, 2.2; 95% CI, 1.9 to 2.4; P < .0001); HCC was an independent predictor of survival. Kaplan-Meier analysis showed a significant improvement in 5-year patient survival with time in patients with HCC (1987 to 1991, 25.3%; 1992 to 1996, 46.6%; 1997 to 2001, 61.1%; P < .0001). During the same period, there was only minimal improvement in survival among the control group. Conclusion: Five-year survival of patients transplanted for HCC is excellent, with a steady improvement in survival over the past decade. It is possible that the published criteria for patient selection may have contributed to the better outcome.

scholarly journals Evaluation of the efficacy and reproducibility of cholangiopancreatography by magnetic resonance for detecting biliary complications following orthotopic liver transplantation

2010 ◽  
Vol 25 (3) ◽  
pp. 249-256 ◽  
Author(s):  
Marcelo Moura Linhares ◽  
Rafael Darahen de Souza Coelho ◽  
Jacob Szejnfeld ◽  
Susan Menasce Goldman ◽  
Adriano Miziara Gonzalez ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Magnetic Resonance ◽  
Orthotopic Liver Transplantation ◽  
Predictive Value ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Tree ◽  
Biliary Complications ◽  
Anastomotic Strictures ◽  
Biliary Anastomosis ◽  
Tree Visualization

PURPOSE: To evaluate the accuracy and reproducibility of magnetic resonance cholangiopancreatography (MRCP) in the detection of biliary complications in liver transplanted patients. METHODS: A study was conducted, with blinded review of 28 MRCP exams of 24 patients submitted to liver transplantation. The images were reviewed by two independent observers, at two different moments, regarding the degree of biliary tree visualization and the presence or absence of biliary complications. The MRCP results were compared, when negative, to at least 3 months of clinical and biochemical follow-up, and when positive, to the findings at surgery or endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The degree of intrahepatic biliary tree visualization was considered good or excellent in 78.6% and 82.1% of the exams by the two observers and visualization of the donor duct, recipient duct and biliary anastomosis was considered good or excellent in 100% of the exams, by both observers. Six biliary complications were detected (21.4%), all of them anastomotic strictures. Intra and interobserver agreement were substantial or almost perfect (kappa k values of 0.611 to 0.804) for the visualization of the biliary tree and almost perfect (k values of 0.900 to 1.000) for the detection of biliary complications. MRCP achieved 100% sensitivity, 95.45% specificity, 85.7% positive predictive value and 100% negative predictive value for the detection of biliary complications. CONCLUSIONS: MRCP is an accurate examination for the detection of biliary complications after orthotopic liver transplantation and it is a highly reproducible method in the evaluation of the biliary tree of liver transplanted patients.

scholarly journals Incidence of biliary complications in living donor liver transplantation

2018 ◽  
Vol 6 (9) ◽  
pp. 3030
Author(s):  
Joseph Varghese
Keyword(s):  
Liver Transplantation ◽  
Biliary Stricture ◽  
Bile Leak ◽  
Biliary Complications ◽  
Sphincter Of Oddi Dysfunction ◽  
Biliary Strictures ◽  
Donor Liver ◽  
Biliary Leak ◽  
Donor Liver Transplantation ◽  
Live Donor Liver

Background: Liver transplantation is a widely accepted treatment for end stage liver diseases and selected cases of hepatocellular carcinoma, if it is limited to the liver. Biliary complications such as biliary strictures and bile leaks after the liver transplantation remain the major cause for morbidity and mortality. This study was aimed to estimate the incidence of biliary complications in live donor liver transplantation (LDLT) patients and the rate of radiological intervention in its management.Methods: Case records of LDLT patients during the past two years were retrospectively studied to estimate the incidence of biliary complications. Biliary complications were diagnosed based on clinical features like pain, fever, jaundice or increased bile from biliary drains. The patients were imaged using ultrasonogram, computed tomogram, magnetic resonance imaging or Endoscopic retrograde cholangiopancreatography (ERCP) for any biliary strictures and leaks, choledocholithiasis or sphincter of oddi dysfunction. The rate of ERCP and Percutaneous Trans Biliary Drainage (PTBD) interventions in these patients was recorded.Results: Fifty cases of post LDLT patients (both prospective and retrospective) were analysed in the study. The incidence of biliary stricture was 12% (6/50) and among the 6 patients with biliary stricture, 4 had bile leak. Among the total cases, the incidence of biliary leak was 8%. Eighty three percent of the biliary complications were managed by ERCP, whilst 17% by PTBD.Conclusions: The incidence of biliary stricture was 12% and biliary leak was 8%. The biliary complications were managed by ERCP in 83% and percutaneous approach in 17% of cases.

scholarly journals Hepatitis C virus recurrence after liver transplantation in Hungary. Trends over the past 10 years

2013 ◽  
Vol 154 (27) ◽  
pp. 1058-1066 ◽  
Author(s):  
Fanni Gelley ◽  
György Gámán ◽  
Zsuzsanna Gerlei ◽  
Gergely Zádori ◽  
Dénes Görög ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Graft Survival ◽  
Patient Survival ◽  
De Novo ◽  
Antiviral Treatment ◽  
Survival Rates ◽  
Early Recurrence ◽  
The Past

Introduction: Management of hepatitis C virus recurrence is a challenge after liver transplantation. Aim: The aim of the authors was to analyse the outcome of liver transplantation performed in hepatitis C virus positive patients during the past ten years and to compare recent data with a previous report of the authors. Method: The authors retrospectively evaluated the data (donors, recipients, perioperative characteristics, patient and graft survival, serum titer of hepatitis C virus RNA, histology) of 409 patients who underwent liver transplantation between 2003 and 2012. Results: 156 patients were transplanted due to hepatitis C virus associated liver cirrhosis (38%). Worse outcome was observed in these patients in comparison to hepatitis C virus negative recipients. The cumulative patient survival rates at 1, 5, and 10 year were 80%, 61%, 51% in the hepatitis C virus positive group and 92%, 85%, 79% in the hepatitis C virus negative group, respectively (p<0.001). The cumulative graft survival rates at 1, 5 and 10 year were 79%, 59% and 50% in hepatitis C virus positive and 89%, 80% and 70% in hepatitis C virus negative patients (p<0.001). Hepatitis C virus recurrence was observed in the majority of the patients (132 patients, 85%), mainly within the first year (83%). The authors observed recurrence within 6 months in 71 patients (56%), and within 3 months in 26 patients (20%). The mean hepatitis C virus recurrence free survival was 243 days. Higher rate of de novo diabetes was detected in case of early recurrence. The cumulative patient survival rates at 1, 3, 5, 10 years were 98%, 89.5%, 81% and 65% when hepatitis C virus recurrence exceeded 3 months and 64%, 53%, 30.5% and 30.5% in patients with early recurrence (p<0.001). Conclusions: Poor outcome of liver transplantation in hepatitis C virus positive patients is still a challenge. Hepatitis C virus recurrence is observed earlier after liver transplantation in comparison with a previous report of the authors. De novo diabetes occurs more frequently in case of early recurrence. Despite an immediate start of antiviral treatment, early recurrence has a significant negative impact on the outcome of transplantation. Orv. Hetil., 2013, 154, 1058–1066.

scholarly journals Survival and Complication of Liver Transplantation in Infants: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Yifu Hou ◽  
Xiaoxiao Wang ◽  
Hongji Yang ◽  
Shan Zhong
Keyword(s):  
Liver Transplantation ◽  
Survival Rate ◽  
Graft Survival ◽  
Patient Survival ◽  
Meta Analysis ◽  
Survival Rates ◽  
Surgical Techniques ◽  
Vascular Complications ◽  
Complication Rates ◽  
Post Transplantation

Background: Modern surgical techniques and scientific advancements have made liver transplant (LT) in infants feasible. However, there are only a small number of studies examining the short- as well as long-term outcomes of LT in this vulnerable subset of children.Methods: Comprehensive searches were done systematically through the PubMed, Scopus, and Google scholar databases. Studies that were retrospective record based or adopted a cohort approach and reported either patient survival rates or graft survival rates or complications of LT in infants were included in the meta-analysis. Statistical analysis was done using STATA version 13.0.Results: A total of 22 studies were included in the meta-analysis. The overall pooled patient survival rate at 1 year, &gt;1–5 years, and &gt;5 years post-transplantation was 85% (95% CI: 78-−92%), 71% (95% CI: 59–83%), and 80% (95% CI: 69–91%), respectively. The overall pooled graft survival rate at 1 year, &gt;1–5 years, and &gt;5 years post-transplantation was 72% (95% CI: 68–76%), 62% (95% CI: 46–78%), and 71% (95% CI: 56–86%), respectively. The overall pooled rate for vascular complications, need for re-transplantation, biliary complications, and infection/sepsis was 12% (95% CI: 10–15%), 16% (95% CI: 12–20%), 15% (95% CI: 9–21%), and 50% (95% CI: 38–61%), respectively.Conclusion: The current meta-analysis showed modest patient and graft survival rates for infant liver transplantation. However, the complication rates related to infection/sepsis were high. More comprehensive evidence is required from studies with larger sample sizes and a longer duration of follow-up.

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