Observational Study of Biliary Duct stenosis in patients with Post-Liver Transplant
Introduction and Objectives: Liver transplant is a surgical procedure indicated in terminal hepatic diseases or patients who fail any other type of treatment. Complications of liver transplant are stenosis of biliary tract, with an incidence of 5-25%, which influences both morbidity and mortality.No...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | Annals of Hepatology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268124002151 |
| _version_ | 1797272462267777024 |
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| author | Raul Sosa-Martinez Daniela A. Garcia-Alonso Julian Vargas-Flores Luis A. Waller-González Mayra V. Ramos-Gomez |
| author_facet | Raul Sosa-Martinez Daniela A. Garcia-Alonso Julian Vargas-Flores Luis A. Waller-González Mayra V. Ramos-Gomez |
| author_sort | Raul Sosa-Martinez |
| collection | DOAJ |
| description | Introduction and Objectives: Liver transplant is a surgical procedure indicated in terminal hepatic diseases or patients who fail any other type of treatment. Complications of liver transplant are stenosis of biliary tract, with an incidence of 5-25%, which influences both morbidity and mortality.Nowadays, treatment has evolved with Endoscopic Retrograde Cholangiopancreatography (ERCP). This treatment consists of dilation, prothesis placement and stents.The main objective of this study consists in describing the clinical characteristics, therapeutic strategies, results and impact in post-liver transplant patients with bile duct stenosis at the National Medical Center “20 de Noviembre”. Materials and Patients: In this retrospective observational study, a total of 39 post-liver transplant patients who presented bile duct stenosis complications were included, receiving endoscopic treatment from 2018 to 2023 with ERCP at the National Medical Center “20 de Noviembre”. Results: A total of 39 post-liver transplant patients with bile duct stenosis were included. The mean age was 49.8 years, with equal distribution between genders. The main causes of liver transplantation were autoimmune diseases (41%) and alcohol-induced liver cirrhosis (23%). The immunosuppressive treatment they received consisted of mycophenolate mofetil (MMF), tacrolimus, and prednisone in 92% of the cases. Regarding endoscopic procedures, a total of 163 ERCP were performed, an average of 4 per patient with prosthesis placement in 64%, mainly plastic (64%). Pneumatic dilation was the most used method (64%). The complication related to endoscopic procedure was cholangitis in 17.9%, without pancreatitis. Bile duct rehabilitation was successful in 64%. Three patients presented death, all related to graft rejection. Conclusions: Bile duct stenosis is a significant complication in post-liver transplant patients, which must be treated individually. Bile duct rehabilitation was successful in more than half of the cases. That said, placement of prosthesis is the most effective strategy in these cases. However, additional research is required to identify success predictors and improve the management of post-transplant complications. |
| first_indexed | 2024-03-07T14:29:42Z |
| format | Article |
| id | doaj.art-0e59818188bf4a4b88402bea87a80503 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-03-07T14:29:42Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-0e59818188bf4a4b88402bea87a805032024-03-06T05:26:04ZengElsevierAnnals of Hepatology1665-26812024-02-0129101421Observational Study of Biliary Duct stenosis in patients with Post-Liver TransplantRaul Sosa-Martinez0Daniela A. Garcia-Alonso1Julian Vargas-Flores2Luis A. Waller-González3Mayra V. Ramos-Gomez4Gastroenterology department, Centro Médico Nacional 20 de noviembre, Mexico CityGastroenterology department, Centro Médico Nacional 20 de noviembre, Mexico CityGastroenterology department, Centro Médico Nacional 20 de noviembre, Mexico CityEndoscopy unit, Centro Médico Nacional 20 de noviembre, Mexico CityGastroenterology department, Centro Médico Nacional 20 de noviembre, Mexico CityIntroduction and Objectives: Liver transplant is a surgical procedure indicated in terminal hepatic diseases or patients who fail any other type of treatment. Complications of liver transplant are stenosis of biliary tract, with an incidence of 5-25%, which influences both morbidity and mortality.Nowadays, treatment has evolved with Endoscopic Retrograde Cholangiopancreatography (ERCP). This treatment consists of dilation, prothesis placement and stents.The main objective of this study consists in describing the clinical characteristics, therapeutic strategies, results and impact in post-liver transplant patients with bile duct stenosis at the National Medical Center “20 de Noviembre”. Materials and Patients: In this retrospective observational study, a total of 39 post-liver transplant patients who presented bile duct stenosis complications were included, receiving endoscopic treatment from 2018 to 2023 with ERCP at the National Medical Center “20 de Noviembre”. Results: A total of 39 post-liver transplant patients with bile duct stenosis were included. The mean age was 49.8 years, with equal distribution between genders. The main causes of liver transplantation were autoimmune diseases (41%) and alcohol-induced liver cirrhosis (23%). The immunosuppressive treatment they received consisted of mycophenolate mofetil (MMF), tacrolimus, and prednisone in 92% of the cases. Regarding endoscopic procedures, a total of 163 ERCP were performed, an average of 4 per patient with prosthesis placement in 64%, mainly plastic (64%). Pneumatic dilation was the most used method (64%). The complication related to endoscopic procedure was cholangitis in 17.9%, without pancreatitis. Bile duct rehabilitation was successful in 64%. Three patients presented death, all related to graft rejection. Conclusions: Bile duct stenosis is a significant complication in post-liver transplant patients, which must be treated individually. Bile duct rehabilitation was successful in more than half of the cases. That said, placement of prosthesis is the most effective strategy in these cases. However, additional research is required to identify success predictors and improve the management of post-transplant complications.http://www.sciencedirect.com/science/article/pii/S1665268124002151 |
| spellingShingle | Raul Sosa-Martinez Daniela A. Garcia-Alonso Julian Vargas-Flores Luis A. Waller-González Mayra V. Ramos-Gomez Observational Study of Biliary Duct stenosis in patients with Post-Liver Transplant Annals of Hepatology |
| title | Observational Study of Biliary Duct stenosis in patients with Post-Liver Transplant |
| title_full | Observational Study of Biliary Duct stenosis in patients with Post-Liver Transplant |
| title_fullStr | Observational Study of Biliary Duct stenosis in patients with Post-Liver Transplant |
| title_full_unstemmed | Observational Study of Biliary Duct stenosis in patients with Post-Liver Transplant |
| title_short | Observational Study of Biliary Duct stenosis in patients with Post-Liver Transplant |
| title_sort | observational study of biliary duct stenosis in patients with post liver transplant |
| url | http://www.sciencedirect.com/science/article/pii/S1665268124002151 |
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