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Article: Biliary casts after orthotopic liver transplantation: Clinical factors, treatment, biochemical analysis

TitleBiliary casts after orthotopic liver transplantation: Clinical factors, treatment, biochemical analysis
Authors
KeywordsChemicals And Cas Registry Numbers
Issue Date2003
PublisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/ajg/index.html
Citation
American Journal Of Gastroenterology, 2003, v. 98 n. 8, p. 1861-1867 How to Cite?
AbstractOBJECTIVES: Biliary casts develop in up to 18% of liver transplant recipients. Casts are associated with morbidity, graft failure, need for retransplantation, and mortality. Proposed etiological mechanisms include acute cellular rejection, ischemia, infection, and biliary obstruction. We aimed to identify clinical features associated with biliary cast formation, review treatments, and analyze the biochemical composition of casts at a single, large, liver transplant center. METHODS: Patient records were reviewed retrospectively to identify patients who developed casts. Data were collected with attention to ischemia, rejection, obstruction, infection, immunosuppression, postoperative biliary drain use, and cast-directed management, and were compared with data from controls. Cast specimens, retrieved at cholangiography, were analyzed with chromatography techniques. RESULTS: Ischemic factors were noted in 70% (7/10) of cast patients versus 15% (6/40) of controls (OR = 13.2; 95% CI = 2.7-66.0; p = 0.001). Biliary strictures were present in 50% of cast patients versus 10% of controls (OR = 9.0; 95% CI = 1.8-45.2; p = 0.01). Differences in cold ischemia time, acute cellular rejection, cyclosporin use, infection, and postoperative biliary drain use were not significant. Casts were successfully treated by endoscopic and percutaneous methods in 60% of patients. One patient died of cast-related complications (mortality 10%). Four casts were in satisfactory condition for biochemical analysis. Bilirubin was the main component (∼10-50%). Bile acid synthesis products and cholesterol comprised smaller percentages, and protein comprised only 5-10%. CONCLUSION: Biliary casts are more likely to develop in the setting of hepatic ischemia and biliary strictures. Endoscopic and percutaneous cast extraction might achieve favorable results and should be attempted before surgical therapy. © 2003 by Am. Coll. of Gastroenterology.
Persistent Identifierhttp://hdl.handle.net/10722/92470
ISSN
2015 Impact Factor: 10.383
2015 SCImago Journal Rankings: 3.946
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorShah, JNen_HK
dc.contributor.authorHaigh, WGen_HK
dc.contributor.authorLee, SPen_HK
dc.contributor.authorLucey, MRen_HK
dc.contributor.authorBrensinger, CMen_HK
dc.contributor.authorKochman, MLen_HK
dc.contributor.authorLong, WBen_HK
dc.contributor.authorOlthoff, Ken_HK
dc.contributor.authorShaked, Aen_HK
dc.contributor.authorGinsberg, GGen_HK
dc.date.accessioned2010-09-17T10:47:14Z-
dc.date.available2010-09-17T10:47:14Z-
dc.date.issued2003en_HK
dc.identifier.citationAmerican Journal Of Gastroenterology, 2003, v. 98 n. 8, p. 1861-1867en_HK
dc.identifier.issn0002-9270en_HK
dc.identifier.urihttp://hdl.handle.net/10722/92470-
dc.description.abstractOBJECTIVES: Biliary casts develop in up to 18% of liver transplant recipients. Casts are associated with morbidity, graft failure, need for retransplantation, and mortality. Proposed etiological mechanisms include acute cellular rejection, ischemia, infection, and biliary obstruction. We aimed to identify clinical features associated with biliary cast formation, review treatments, and analyze the biochemical composition of casts at a single, large, liver transplant center. METHODS: Patient records were reviewed retrospectively to identify patients who developed casts. Data were collected with attention to ischemia, rejection, obstruction, infection, immunosuppression, postoperative biliary drain use, and cast-directed management, and were compared with data from controls. Cast specimens, retrieved at cholangiography, were analyzed with chromatography techniques. RESULTS: Ischemic factors were noted in 70% (7/10) of cast patients versus 15% (6/40) of controls (OR = 13.2; 95% CI = 2.7-66.0; p = 0.001). Biliary strictures were present in 50% of cast patients versus 10% of controls (OR = 9.0; 95% CI = 1.8-45.2; p = 0.01). Differences in cold ischemia time, acute cellular rejection, cyclosporin use, infection, and postoperative biliary drain use were not significant. Casts were successfully treated by endoscopic and percutaneous methods in 60% of patients. One patient died of cast-related complications (mortality 10%). Four casts were in satisfactory condition for biochemical analysis. Bilirubin was the main component (∼10-50%). Bile acid synthesis products and cholesterol comprised smaller percentages, and protein comprised only 5-10%. CONCLUSION: Biliary casts are more likely to develop in the setting of hepatic ischemia and biliary strictures. Endoscopic and percutaneous cast extraction might achieve favorable results and should be attempted before surgical therapy. © 2003 by Am. Coll. of Gastroenterology.en_HK
dc.languageengen_HK
dc.publisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/ajg/index.htmlen_HK
dc.relation.ispartofAmerican Journal of Gastroenterologyen_HK
dc.subjectChemicals And Cas Registry Numbersen_HK
dc.titleBiliary casts after orthotopic liver transplantation: Clinical factors, treatment, biochemical analysisen_HK
dc.typeArticleen_HK
dc.identifier.emailLee, SP: sumlee@hku.hken_HK
dc.identifier.authorityLee, SP=rp01351en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/j.1572-0241.2003.07617.xen_HK
dc.identifier.pmid12907345-
dc.identifier.scopuseid_2-s2.0-0041571839en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0041571839&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume98en_HK
dc.identifier.issue8en_HK
dc.identifier.spage1861en_HK
dc.identifier.epage1867en_HK
dc.identifier.isiWOS:000184584900029-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridShah, JN=7403262375en_HK
dc.identifier.scopusauthoridHaigh, WG=6603814152en_HK
dc.identifier.scopusauthoridLee, SP=7601417497en_HK
dc.identifier.scopusauthoridLucey, MR=7006176605en_HK
dc.identifier.scopusauthoridBrensinger, CM=7004184866en_HK
dc.identifier.scopusauthoridKochman, ML=7004919683en_HK
dc.identifier.scopusauthoridLong, WB=14629164700en_HK
dc.identifier.scopusauthoridOlthoff, K=7006297342en_HK
dc.identifier.scopusauthoridShaked, A=7007027236en_HK
dc.identifier.scopusauthoridGinsberg, GG=35371124300en_HK

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