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Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome
AIM: To identify factors predicting outcome of endoscopic therapy in bile duct strictures (BDS) post living donor liver transplantation (LDLT). METHODS: Patients referred with BDS post LDLT, were retrospectively studied. Patient demographics, symptoms (Pruritus, Jaundice, cholangitis), intra-op vari...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437505/ https://www.ncbi.nlm.nih.gov/pubmed/28573070 http://dx.doi.org/10.4291/wjgp.v8.i2.77 |
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author | Rao, Harshavardhan B Ahamed, Hasim Panicker, Suprabha Sudhindran, Surendran Venu, Rama P |
author_facet | Rao, Harshavardhan B Ahamed, Hasim Panicker, Suprabha Sudhindran, Surendran Venu, Rama P |
author_sort | Rao, Harshavardhan B |
collection | PubMed |
description | AIM: To identify factors predicting outcome of endoscopic therapy in bile duct strictures (BDS) post living donor liver transplantation (LDLT). METHODS: Patients referred with BDS post LDLT, were retrospectively studied. Patient demographics, symptoms (Pruritus, Jaundice, cholangitis), intra-op variables (cold ischemia time, blood transfusions, number of ducts used, etc.), peri-op complications [hepatic artery thrombosis (HAT), bile leak, infections], stricture morphology (length, donor and recipient duct diameters) and relevant laboratory data both pre- and post-endotherapy were studied. Favourable response to endotherapy was defined as symptomatic relief with > 80% reduction in total bilirubin/serum gamma glutamyl transferase. Statistical analysis was performed using SPSS 20.0. RESULTS: Forty-one patients were included (age: 8-63 years). All had right lobe LDLT with duct-to-duct anastomosis. Twenty patients (48.7%) had favourable response to endotherapy. Patients with single duct anastomosis, aggressive stent therapy (multiple endoscopic retrograde cholagiography, upsizing of stents, dilatation and longer duration of stents) and an initial favourable response to endotherapy were independent predictors of good outcome (P < 0.05). Older donor age, HAT, multiple ductal anastomosis and persistent bile leak (> 4 wk post LT) were found to be significant predictors of poor response on multivariate analysis (P < 0.05). CONCLUSION: Endoscopic therapy with aggressive stent therapy especially in patients with single duct-to-duct anastomosis was associated with a better outcome. Multiple ductal anastomosis, older donor age, shorter duration of stent therapy, early bile leak and HAT were predictors of poor outcome with endotherapy in these patients. |
format | Online Article Text |
id | pubmed-5437505 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-54375052017-06-01 Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome Rao, Harshavardhan B Ahamed, Hasim Panicker, Suprabha Sudhindran, Surendran Venu, Rama P World J Gastrointest Pathophysiol Observational Study AIM: To identify factors predicting outcome of endoscopic therapy in bile duct strictures (BDS) post living donor liver transplantation (LDLT). METHODS: Patients referred with BDS post LDLT, were retrospectively studied. Patient demographics, symptoms (Pruritus, Jaundice, cholangitis), intra-op variables (cold ischemia time, blood transfusions, number of ducts used, etc.), peri-op complications [hepatic artery thrombosis (HAT), bile leak, infections], stricture morphology (length, donor and recipient duct diameters) and relevant laboratory data both pre- and post-endotherapy were studied. Favourable response to endotherapy was defined as symptomatic relief with > 80% reduction in total bilirubin/serum gamma glutamyl transferase. Statistical analysis was performed using SPSS 20.0. RESULTS: Forty-one patients were included (age: 8-63 years). All had right lobe LDLT with duct-to-duct anastomosis. Twenty patients (48.7%) had favourable response to endotherapy. Patients with single duct anastomosis, aggressive stent therapy (multiple endoscopic retrograde cholagiography, upsizing of stents, dilatation and longer duration of stents) and an initial favourable response to endotherapy were independent predictors of good outcome (P < 0.05). Older donor age, HAT, multiple ductal anastomosis and persistent bile leak (> 4 wk post LT) were found to be significant predictors of poor response on multivariate analysis (P < 0.05). CONCLUSION: Endoscopic therapy with aggressive stent therapy especially in patients with single duct-to-duct anastomosis was associated with a better outcome. Multiple ductal anastomosis, older donor age, shorter duration of stent therapy, early bile leak and HAT were predictors of poor outcome with endotherapy in these patients. Baishideng Publishing Group Inc 2017-05-15 2017-05-15 /pmc/articles/PMC5437505/ /pubmed/28573070 http://dx.doi.org/10.4291/wjgp.v8.i2.77 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Observational Study Rao, Harshavardhan B Ahamed, Hasim Panicker, Suprabha Sudhindran, Surendran Venu, Rama P Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome |
title | Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome |
title_full | Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome |
title_fullStr | Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome |
title_full_unstemmed | Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome |
title_short | Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome |
title_sort | endoscopic therapy for biliary strictures complicating living donor liver transplantation: factors predicting better outcome |
topic | Observational Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437505/ https://www.ncbi.nlm.nih.gov/pubmed/28573070 http://dx.doi.org/10.4291/wjgp.v8.i2.77 |
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