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Article: Biliary complications after adult-to-adult living-donor liver transplantation: An international multicenter study of 3633 cases

TitleBiliary complications after adult-to-adult living-donor liver transplantation: An international multicenter study of 3633 cases
Authors
Keywordsbile leak
biliary anastomotic stricture
biliary complications
liver transplantation
living-donor liver transplantation
Issue Date28-Feb-2024
PublisherElsevier
Citation
American Journal of Transplantation, 2024 How to Cite?
Abstract

In living-donor liver transplantation, biliary complications including bile leaks and biliary anastomotic strictures remain significant challenges, with incidences varying across different centers. This multicentric retrospective study (2016-2020) included 3633 adult patients from 18 centers and aimed to identify risk factors for these biliary complications and their impact on patient survival. Incidences of bile leaks and biliary strictures were 11.4% and 20.6%, respectively. Key risk factors for bile leaks included multiple bile duct anastomoses (odds ratio, [OR] 1.8), Roux-en-Y hepaticojejunostomy (OR, 1.4), and a history of major abdominal surgery (OR, 1.4). For biliary anastomotic strictures, risk factors were ABO incompatibility (OR, 1.4), blood loss >1 L (OR, 1.4), and previous abdominal surgery (OR, 1.7). Patients experiencing biliary complications had extended hospital stays, increased incidence of major complications, and higher comprehensive complication index scores. The impact on graft survival became evident after accounting for immortal time bias using time-dependent covariate survival analysis. Bile leaks and biliary anastomotic strictures were associated with adjusted hazard ratios of 1.7 and 1.8 for graft survival, respectively. The study underscores the importance of minimizing these risks through careful donor selection and preoperative planning, as biliary complications significantly affect graft survival, despite the availability of effective treatments.


Persistent Identifierhttp://hdl.handle.net/10722/342143
ISSN
2023 Impact Factor: 8.9
2023 SCImago Journal Rankings: 2.688

 

DC FieldValueLanguage
dc.contributor.authorLi, Zhihao-
dc.contributor.authorRammohan, Ashwin-
dc.contributor.authorGunasekaran, Vasanthakumar-
dc.contributor.authorHong, Suyoung-
dc.contributor.authorChih-Yi, Chen Itsuko-
dc.contributor.authorKim, Jongman-
dc.contributor.authorHervera, Marquez Kris Ann-
dc.contributor.authorHsu, Shih-Chao-
dc.contributor.authorKirimker, Elvan Onur-
dc.contributor.authorAkamatsu, Nobuhisa-
dc.contributor.authorShaked, Oren-
dc.contributor.authorFinotti, Michele-
dc.contributor.authorYeow, Marcus-
dc.contributor.authorGenedy, Lara-
dc.contributor.authorDutkowski, Philipp-
dc.contributor.authorNadalin, Silvio-
dc.contributor.authorBoehnert, Markus U-
dc.contributor.authorPolak, Wojciech G-
dc.contributor.authorBonney, Glenn K-
dc.contributor.authorMathur, Abhishek-
dc.contributor.authorSamstein, Benjamin-
dc.contributor.authorEmond, Jean C-
dc.contributor.authorTesta, Giuliano-
dc.contributor.authorOlthoff, Kim M-
dc.contributor.authorRosen, Charles B-
dc.contributor.authorHeimbach, Julie K-
dc.contributor.authorTaner, Timucin-
dc.contributor.authorWong, Tiffany CL-
dc.contributor.authorLo, Chung-Mau-
dc.contributor.authorHasegawa, Kiyoshi-
dc.contributor.authorBalci, Deniz-
dc.contributor.authorCattral, Mark-
dc.contributor.authorSapisochin, Gonzalo-
dc.contributor.authorSelzner, Nazia-
dc.contributor.authorJeng, Long-Bin-
dc.contributor.authorBroering, Dieter-
dc.contributor.authorJoh, Jae-Won-
dc.contributor.authorChen, Chao-Long-
dc.contributor.authorSuh, Kyung-Suk-
dc.contributor.authorRela, Mohamed-
dc.contributor.authorClavien, Pierre-Alain-
dc.date.accessioned2024-04-09T07:30:03Z-
dc.date.available2024-04-09T07:30:03Z-
dc.date.issued2024-02-28-
dc.identifier.citationAmerican Journal of Transplantation, 2024-
dc.identifier.issn1600-6135-
dc.identifier.urihttp://hdl.handle.net/10722/342143-
dc.description.abstract<p>In living-donor liver transplantation, biliary complications including bile leaks and biliary anastomotic strictures remain significant challenges, with incidences varying across different centers. This multicentric retrospective study (2016-2020) included 3633 adult patients from 18 centers and aimed to identify risk factors for these biliary complications and their impact on patient survival. Incidences of bile leaks and biliary strictures were 11.4% and 20.6%, respectively. Key risk factors for bile leaks included multiple bile duct anastomoses (odds ratio, [OR] 1.8), Roux-en-Y hepaticojejunostomy (OR, 1.4), and a history of major abdominal surgery (OR, 1.4). For biliary anastomotic strictures, risk factors were ABO incompatibility (OR, 1.4), blood loss >1 L (OR, 1.4), and previous abdominal surgery (OR, 1.7). Patients experiencing biliary complications had extended hospital stays, increased incidence of major complications, and higher comprehensive complication index scores. The impact on graft survival became evident after accounting for immortal time bias using time-dependent covariate survival analysis. Bile leaks and biliary anastomotic strictures were associated with adjusted hazard ratios of 1.7 and 1.8 for graft survival, respectively. The study underscores the importance of minimizing these risks through careful donor selection and preoperative planning, as biliary complications significantly affect graft survival, despite the availability of effective treatments.</p>-
dc.languageeng-
dc.publisherElsevier-
dc.relation.ispartofAmerican Journal of Transplantation-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectbile leak-
dc.subjectbiliary anastomotic stricture-
dc.subjectbiliary complications-
dc.subjectliver transplantation-
dc.subjectliving-donor liver transplantation-
dc.titleBiliary complications after adult-to-adult living-donor liver transplantation: An international multicenter study of 3633 cases-
dc.typeArticle-
dc.identifier.doi10.1016/j.ajt.2024.02.023-
dc.identifier.scopuseid_2-s2.0-85187976877-
dc.identifier.eissn1600-6143-
dc.identifier.issnl1600-6135-

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