title: Diffuse biliary tract injury after orthotopic liver transplantation.
abstract: An unusual type of diffuse biliary tract injury after liver transplantation that is characterized by multiple intrahepatic biliary strictures, ductal dilatations, fluid collections, or intrahepatic abscesses has been identified. Over a 5-year period, a total of 10 patients (2%) developed diffuse intrahepatic biliary injury with established vascular patency and no obvious source for their biliary tract pathology. All patients received livers preserved in University of Wisconsin solution with a mean preservation time of 16 hours. This biliary tract injury was associated with the presence of severe preservation injury and Roux limb biliary reconstruction. Of the 10 patients, 5 were treated nonoperatively with multiple stricture dilations and stent placements, 3 underwent retransplantation, 1 was treated operatively with hepaticojejunostomy, and 1 died of sepsis. This study suggests that this complication appears to be related to preservation injury and that the etiology may be ischemic in origin.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.
authors.forename: S
authors.initials: S
authors.lastname: Li
authors.forename: R J
authors.initials: RJ
authors.lastname: Stratta
authors.forename: A N
authors.initials: AN
authors.lastname: Langnas
authors.forename: R P
authors.initials: RP
authors.lastname: Wood
authors.forename: W
authors.initials: W
authors.lastname: Marujo
authors.forename: B W
authors.initials: BW
authors.lastname: Shaw
mesh_terms: D000241:Adenosine; D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000493:Allopurinol; D001219:Aspartate Aminotransferases / Q000097:blood; D001649:Bile Duct Diseases / Q000209:etiology; D001660:Biliary Tract Diseases / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D002761:Cholangitis / Q000209:etiology; D005500:Follow-Up Studies; D005978:Glutathione; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D006982:Hypertonic Solutions / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin; D007565:Jaundice / Q000209:etiology; D008099:Liver / Q000503:physiopathology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000502:physiology; D008875:Middle Aged; D009926:Organ Preservation; D019188:Organ Preservation Solutions; D011887:Raffinose; D012086:Reoperation; D012189:Retrospective Studies; D012996:Solutions / Q000008:administration & dosage; D013927:Thrombosis / Q000209:etiology
chemical_list: C037096:Euro-Collins' solution; D006982:Hypertonic Solutions; D007328:Insulin; D019188:Organ Preservation Solutions; D012996:Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose