scholarly journals Anastomose Biliar no Transplante Hepático: Com ou Sem Tubo em T?

2017 ◽  
Vol 30 (2) ◽  
pp. 122
Author(s):  
Janine Carmelino ◽  
Susana Rodrigues ◽  
Hugo Pinto Marques ◽  
Vasco Ribeiro ◽  
Daniel Virella ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Logistic Regression ◽  
Explanatory Models ◽  
Biliary Fistula ◽  
Biliary Complications ◽  
Cold Ischemia ◽  
Liver Transplants ◽  
Endoscopic Retrograde ◽  
T Tube ◽  
Case Based

Introduction: Biliary complications occur in 10-30% of liver transplants. The aim of this study was to compare the incidence of these complications in liver transplants when the T-tube was or was not used during the biliary anastomosis.Material and Methods: Analysis of 2 groups of patients undergoing liver transplantation between 2008 and 2012. Patients were divided considering if the T-tube was used (G1) or if it was not (G2). We sought explanatory models of the occurrence of biliary complications by logistic regression, including the variables identified in the univariate analysis.Results: We reviewed 506 consecutive patients who underwent a first liver transplant (G1 = 363, G2 = 143). The overall incidence of biliary complications was 24.7% (95% CI 21.1 to 28.6): 27.0% in G1 and 18.9% in G2 (p = 0.057). The incidences of stenosis and biliary fistula tended to be higher in G1: 19.6% (95% CI 15.7 to 23.8) vs 15.4% (95% CI 10.1 to 22.0) (p = 0.275) and 6.6% (95% CI 4.4 to 9.5) vs 2.8% (95% CI 0.9 to 6.6) (p = 0.091). We did not find statistically significant differences in the rates of endoscopic retrograde cholangiopancreatography, reoperation and retransplantation. There were two deaths in G1. There was no association between the occurrence of biliary complications and the diameters of the biliary tract nor the time of cold ischemia. The explanatory model, adjusted to the recipient and the donor age’s and to the initial diagnosis, identifies the use of the T-tube as increasing the possibility of the occurrence of biliary complications (AdjOR 1.71, 95% CI 1.04 to 2.80; p = 0.034).Discussion and Conclusion: The use of the T-tube should be a decision taken on a case-based intraoperative judgment of experienced surgeons

scholarly journals Impact of early biliary complications in liver transplantation in the presence or absence of a T-tube: a Chinese transplant centre experience

2007 ◽  
Vol 83 (976) ◽  
pp. 120-123 ◽  
Author(s):  
T. Li ◽  
Z.-S. Chen ◽  
F.-J. Zeng ◽  
C.-S. Ming ◽  
W.-J. Zhang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Biliary Complications ◽  
T Tube ◽  
Transplant Centre

scholarly journals Endoscopic Management of Biliary Complications following Liver Transplantation after Donation from Cardiac Death Donors

2012 ◽  
Vol 26 (9) ◽  
pp. 607-610 ◽  
Author(s):  
Kris P Croome ◽  
Vivian McAlister ◽  
Paul Adams ◽  
Paul Marotta ◽  
William Wall ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Cardiac Death ◽  
Hepatic Duct ◽  
Biliary Complications ◽  
Endoscopic Management ◽  
Transplant Recipients ◽  
Biliary Strictures ◽  
Liver Transplants ◽  
Liver Transplant Recipients

BACKGROUND Previous studies have shown a higher incidence of biliary complications following donation after cardiac death (DCD) liver transplantation compared with donation after brain death (DBD) liver transplantation. The endoscopic management of ischemic type biliary strictures in patients who have undergone DCD liver transplants needs to be characterized further.METHODS: A retrospective institutional review of all patients who underwent DCD liver transplant from January 2006 to September 2011 was performed. These patients were compared with all patients who underwent DBD liver transplantation in the same time period. A descriptive analysis of all DCD patients who developed biliary complications and their subsequent endoscopic management was also performed.RESULTS: Of the 36 patients who received DCD liver transplants, 25% developed biliary complications compared with 13% of patients who received DBD liver transplants (P=0.062). All DCD allograft recipients who developed biliary complications became symptomatic within three months of transplantation. Ischemic type biliary strictures in DCD allograft recipients included disseminated biliary strictures in two patients, biliary strictures of the hepatic duct bifurcation in three patients and biliary strictures of the donor common hepatic duct in three patients.CONCLUSIONS: There was a trend toward increasing incidence of total biliary complications in recipients of DCD liver allografts compared with those receiving DBD livers, and the rate of diffuse ischemic cholangiopathy was significantly higher. Focal ischemic type biliary strictures can be treated effectively in DCD liver transplant recipients with favourable results. Diffuse ischemic type biliary strictures in DCD liver transplant recipients ultimately requires retransplantation.

The influence of cold ischemia time on biliary complications following liver transplantation

1994 ◽  
Vol 21 (3) ◽  
pp. 340-346 ◽  
Author(s):  
Michel Scotté ◽  
Bertrand Dousset ◽  
Yvon Calmus ◽  
Filomena Conti ◽  
Didier Houssin ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Biliary Complications ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Ischemia Time

scholarly journals Morphological Characteristics of Biliary Strictures after Liver Transplantation Visualized Using SpyGlass™ Cholangioscopy

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yathip M. Chokpapone ◽  
Anne R. Murray ◽  
Ashwini P. Mehta ◽  
Vichin C. Puri ◽  
Alejandro Mejia ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Morphological Characteristics ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Complications ◽  
Direct Visualization ◽  
Biliary Strictures ◽  
Endoscopic Retrograde ◽  
Visualization System ◽  
Transplant Patients

Biliary complications following liver transplant are common. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) are the main techniques used to diagnose and treat biliary complications; however, these techniques have limits to the depth of visualization. In this report, we present five cases of orthotopic liver transplant patients with biliary complications that underwent ERCP- or MRCP-guided cholangioscopy with the SpyGlass™ DS Direct Visualization System (SDDVS). The SDDVS allowed for the visualization of the morphological characteristics of biliary strictures, and images collected using the SDDVS allowed for four of the cases to be treated endoscopically. Our findings suggest that cholangioscopy with the SDDVS is a promising method to guide the endoscopic treatment of biliary complications after liver transplantation.

scholarly journals Usefulness of T-Tube in Liver Transplantation: Still Effective or Outmoded Strategy?

2021 ◽  
Vol 2 (4) ◽  
pp. 379-386
Author(s):  
Niccolò Incarbone ◽  
Riccardo De Carlis ◽  
Leonardo Centonze ◽  
Livia Palmieri ◽  
Giuseppe Cordaro ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
High Risk ◽  
Postoperative Complications ◽  
Anastomotic Stricture ◽  
Low Risk ◽  
Biliary Complications ◽  
Tube Placement ◽  
Post Transplant ◽  
T Tube ◽  
High Risk Cohort

Introduction: T-tube placement during liver transplantation (LT) is still debated. We performed a retrospective study to evaluate the usefulness of T-tube after LT in two cohorts differing in post-transplant risk. Methods: A total of 327 LTs performed between 2015 and 2018 were included in the analysis. LTs from donation after circulatory death and living donation, split-liver transplants, and LTs with hepaticojejunostomy were excluded. T-tube was reserved for marginal grafts, high-risk recipients, and bile duct size discrepancy. A balance of risk (BAR) score of ≤9 defined the low-risk cohort (232 patients, 68 with and 164 without T-tube), while a BAR score of >9 defined the high-risk cohort (95 patients, 43 with and 52 without T-tube). Postoperative complications were estimated with the comprehensive complication index (CCI). Postoperative biliary complications were classified in anastomotic stricture (AS), non-anastomotic stricture (NAS), and biliary leakage (BL). Results: In the low-risk cohort, LTs with and without T-tube had similar rates of NAS (0 vs. 2.9%, p = 0.36), AS (2.9 vs. 2.4%, p = 0.83), and BL (1.4 vs. 2.4%, p = 0.64). Analogous outcomes were found in the high-risk cohort: NAS (0 vs. 0), AS (0 vs. 5.7%, p = 0.11), and BL (0 vs. 1.3%, p = 0.27). There were more postoperative complications among patients with T-tube, in both the low-risk (CCI 29 vs. 21, p < 0.001) and high-risk (CCI 51 vs. 29, p < 0.001) cohort. No differences in primary non-function, hepatic artery thrombosis, and mortality were observed. Conclusions: T-tube placement did not influence postoperative biliary complications. Although the two cohorts were normalized for post-transplant risk, LT recipients with T-tube had a more complicated course.

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