Intrahepatic biliary strictures without hepatic artery thrombosis after liver transplantation

An analysis of 1,113 liver transplantations at a single center

Noboru Nakamura, Seigo Nishida, Guy R. Neff, Anil Vaidya, David M. Levi, Tomoaki Kato, Phillip Ruiz, Andreas G. Tzakis, Juan R. Madariaga

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

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 11 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 IHBS (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.

Original languageEnglish
Pages (from-to)427-432
Number of pages6
JournalTransplantation
Volume79
Issue number4
DOIs
StatePublished - Feb 27 2005

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Hepatic Artery
Liver Transplantation
Pathologic Constriction
Thrombosis
Tissue Donors
Transplants
Incidence
Graft Survival
Heart Arrest

Keywords

  • Biliary complications
  • Hepatic artery thrombosis (HAT)
  • Intrahepatic biliary strictures (IHBS)
  • Liver transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Intrahepatic biliary strictures without hepatic artery thrombosis after liver transplantation : An analysis of 1,113 liver transplantations at a single center. / Nakamura, Noboru; Nishida, Seigo; Neff, Guy R.; Vaidya, Anil; Levi, David M.; Kato, Tomoaki; Ruiz, Phillip; Tzakis, Andreas G.; Madariaga, Juan R.

In: Transplantation, Vol. 79, No. 4, 27.02.2005, p. 427-432.

Research output: Contribution to journalArticle

Nakamura, Noboru ; Nishida, Seigo ; Neff, Guy R. ; Vaidya, Anil ; Levi, David M. ; Kato, Tomoaki ; Ruiz, Phillip ; Tzakis, Andreas G. ; Madariaga, Juan R. / Intrahepatic biliary strictures without hepatic artery thrombosis after liver transplantation : An analysis of 1,113 liver transplantations at a single center. In: Transplantation. 2005 ; Vol. 79, No. 4. pp. 427-432.
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abstract = "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 11 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 IHBS (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.",
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T1 - Intrahepatic biliary strictures without hepatic artery thrombosis after liver transplantation

T2 - An analysis of 1,113 liver transplantations at a single center

AU - Nakamura, Noboru

AU - Nishida, Seigo

AU - Neff, Guy R.

AU - Vaidya, Anil

AU - Levi, David M.

AU - Kato, Tomoaki

AU - Ruiz, Phillip

AU - Tzakis, Andreas G.

AU - Madariaga, Juan R.

PY - 2005/2/27

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N2 - 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 11 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 IHBS (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.

AB - 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 11 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 IHBS (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.

KW - Biliary complications

KW - Hepatic artery thrombosis (HAT)

KW - Intrahepatic biliary strictures (IHBS)

KW - Liver transplantation

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