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Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy?

Background: Non-anastomotic biliary strictures (NAS) are a common cause of morbidity and mortality after liver transplantation. Methods: All patients with NAS from 2008 to 2016 were retrospectively analyzed. The success rate and overall mortality of an ERCP-based stent program (EBSP) were the primar...

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Autores principales: Michael, Florian A., Friedrich-Rust, Mireen, Erasmus, Hans-Peter, Graf, Christiana, Ballo, Olivier, Knabe, Mate, Walter, Dirk, Steup, Christoph D., Mücke, Marcus M., Mücke, Victoria T., Peiffer, Kai H., Görgülü, Esra, Mondorf, Antonia, Bechstein, Wolf O., Filmann, Natalie, Zeuzem, Stefan, Bojunga, Jörg, Finkelmeier, Fabian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10219240/
https://www.ncbi.nlm.nih.gov/pubmed/37240598
http://dx.doi.org/10.3390/jcm12103491
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author Michael, Florian A.
Friedrich-Rust, Mireen
Erasmus, Hans-Peter
Graf, Christiana
Ballo, Olivier
Knabe, Mate
Walter, Dirk
Steup, Christoph D.
Mücke, Marcus M.
Mücke, Victoria T.
Peiffer, Kai H.
Görgülü, Esra
Mondorf, Antonia
Bechstein, Wolf O.
Filmann, Natalie
Zeuzem, Stefan
Bojunga, Jörg
Finkelmeier, Fabian
author_facet Michael, Florian A.
Friedrich-Rust, Mireen
Erasmus, Hans-Peter
Graf, Christiana
Ballo, Olivier
Knabe, Mate
Walter, Dirk
Steup, Christoph D.
Mücke, Marcus M.
Mücke, Victoria T.
Peiffer, Kai H.
Görgülü, Esra
Mondorf, Antonia
Bechstein, Wolf O.
Filmann, Natalie
Zeuzem, Stefan
Bojunga, Jörg
Finkelmeier, Fabian
author_sort Michael, Florian A.
collection PubMed
description Background: Non-anastomotic biliary strictures (NAS) are a common cause of morbidity and mortality after liver transplantation. Methods: All patients with NAS from 2008 to 2016 were retrospectively analyzed. The success rate and overall mortality of an ERCP-based stent program (EBSP) were the primary outcomes. Results: A total of 40 (13.9%) patients with NAS were identified, of which 35 patients were further treated in an EBSP. Furthermore, 16 (46%) patients terminated EBSP successfully, and nine (26%) patients died during the program. All deaths were caused by cholangitis. Of those, one (11%) patient had an extrahepatic stricture, while the other eight patients had either intrahepatic (3, 33%) or combined extra- and intrahepatic strictures (5, 56%). Risk factors of overall mortality were age (p = 0.03), bilirubin (p < 0.0001), alanine transaminase (p = 0.006), and aspartate transaminase (p = 0.0003). The median duration of the stent program was 34 months (ITBL: 36 months; IBL: 10 months), and procedural complications were rare. Conclusions: EBSP is safe, but lengthy and successful in only about half the patients. Intrahepatic strictures were associated with an increased risk of cholangitis.
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spelling pubmed-102192402023-05-27 Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy? Michael, Florian A. Friedrich-Rust, Mireen Erasmus, Hans-Peter Graf, Christiana Ballo, Olivier Knabe, Mate Walter, Dirk Steup, Christoph D. Mücke, Marcus M. Mücke, Victoria T. Peiffer, Kai H. Görgülü, Esra Mondorf, Antonia Bechstein, Wolf O. Filmann, Natalie Zeuzem, Stefan Bojunga, Jörg Finkelmeier, Fabian J Clin Med Article Background: Non-anastomotic biliary strictures (NAS) are a common cause of morbidity and mortality after liver transplantation. Methods: All patients with NAS from 2008 to 2016 were retrospectively analyzed. The success rate and overall mortality of an ERCP-based stent program (EBSP) were the primary outcomes. Results: A total of 40 (13.9%) patients with NAS were identified, of which 35 patients were further treated in an EBSP. Furthermore, 16 (46%) patients terminated EBSP successfully, and nine (26%) patients died during the program. All deaths were caused by cholangitis. Of those, one (11%) patient had an extrahepatic stricture, while the other eight patients had either intrahepatic (3, 33%) or combined extra- and intrahepatic strictures (5, 56%). Risk factors of overall mortality were age (p = 0.03), bilirubin (p < 0.0001), alanine transaminase (p = 0.006), and aspartate transaminase (p = 0.0003). The median duration of the stent program was 34 months (ITBL: 36 months; IBL: 10 months), and procedural complications were rare. Conclusions: EBSP is safe, but lengthy and successful in only about half the patients. Intrahepatic strictures were associated with an increased risk of cholangitis. MDPI 2023-05-16 /pmc/articles/PMC10219240/ /pubmed/37240598 http://dx.doi.org/10.3390/jcm12103491 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Michael, Florian A.
Friedrich-Rust, Mireen
Erasmus, Hans-Peter
Graf, Christiana
Ballo, Olivier
Knabe, Mate
Walter, Dirk
Steup, Christoph D.
Mücke, Marcus M.
Mücke, Victoria T.
Peiffer, Kai H.
Görgülü, Esra
Mondorf, Antonia
Bechstein, Wolf O.
Filmann, Natalie
Zeuzem, Stefan
Bojunga, Jörg
Finkelmeier, Fabian
Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy?
title Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy?
title_full Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy?
title_fullStr Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy?
title_full_unstemmed Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy?
title_short Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy?
title_sort treatment of non-anastomotic biliary strictures after liver transplantation: how effective is our current treatment strategy?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10219240/
https://www.ncbi.nlm.nih.gov/pubmed/37240598
http://dx.doi.org/10.3390/jcm12103491
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