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KMID : 1143920220260010076
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Annals of Hepato-Biliary-Pancreatic Surgery
2022 Volume.26 No. 1 p.76 ~ p.83
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Early laboratory values after liver transplantation are associated with anastomotic biliary strictures
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Fasullo Matthew
Kandakatla Priyanush
Amerinasab Reza
Kohli Divyanshoo Rai
Shah Tilak
Patel Samarth
Bhati Chandra Shekhar
Bouhaidar Doumit
Siddiqui Mohammad S.
Vachhani Ravi
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Abstract
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Backgrounds/Aims: The aim of this study was to evaluate longitudinal changes of post-liver transplantation (LT) biliary anatomy and to assess the association of increased laboratory values after LT with the development of post-LT anastomotic biliary stricture (ABS).
Methods: Adult deceased donor LT recipients from 2008 and 2019 were evaluated. ABS was defined after blinded review of endoscopic cholangiograms. Controls were patients who underwent LT for hepatocellular carcinoma who did not have any clinical or biochemical concerns for ABS.
Results: Of 534 patients who underwent LT, 57 patients had ABS and 57 patients served as controls. On MRI, ABS patients had a narrower anastomosis (2.47 ± 1.32 mm vs. 3.38 ± 1.05 mm; p < 0.01) and wider bile duct at 1-cm proximal to the anastomosis (6.73 ± 2.45 mm vs. 5.66 ± 1.95 mm; p = 0.01) than controls. Association between labs at day 7 and ABS formation was as follows: aspartate aminotransferase hazard ratio (HR): 1.014; 95% confidence interval (CI): 1.008?1.020, p = 0.001; total bilirubin HR: 1.292, 95% CI: 1.100?1.517, p = 0.002; and conjugated bilirubin HR: 1.467, 95% CI: 1.216?1.768, p = 0.001. Corresponding analysis results for day 28 were alanine aminotransferase HR: 1.004, 95% CI: 1.002?1.006, p = 0.001; alkaline phosphatase HR: 1.005, 95% CI: 1.003?1.007, p = 0.001; total bilirubin HR: 1.233, 95% CI: 1.110?1.369, p = 0.001; and conjugated bilirubin HR: 1.272, 95% CI: 1.126?1.437, p = 0.001.
Conclusions: Elevation of laboratory values early after LT is associated with ABS formation.
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KEYWORD
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Liver transplantation, Common bile duct, Cholangiopancreatography, endoscopic retrograde, Bile ducts, Magnetic resonance imaging
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