title: Ischemic-type biliary complications after orthotopic liver transplantation.
abstract: Nonanastomotic biliary strictures that involve only the biliary tree of the graft occur after orthotopic liver transplantation in patients with hepatic artery thrombosis, chronic ductopenic rejection and ABO blood group incompatibility. This complication may also occur in the absence of these known risk factors. The major focus of our study was to evaluate the risk factors for nonanastomotic biliary stricturing of unknown cause after orthotopic liver transplantation. Results demonstrate that the development of biliary strictures is strongly associated with the duration of cold ischemic storage of allografts in both Euro-Collins solution and University of Wisconsin solution. Results also demonstrate that strictures are not associated with the type of biliary reconstruction, the primary liver disease, cytomegalovirus infection, allograft rejection or the presence of a positive lymphocytotoxic crossmatch. More recently, we have markedly reduced the occurrence of nonanastomotic biliary stricturing by decreasing the ischemia time of our allografts. Thus nonanastomotic biliary strictures appear to be the result of the ischemia/reperfusion-induced tissue injury associated with the harvest and implantation of allografts.
authors.affiliation: Section of Transplantation Surgery, Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: L
authors.initials: L
authors.lastname: Sanchez-Urdazpal
authors.forename: G J
authors.initials: GJ
authors.lastname: Gores
authors.forename: E M
authors.initials: EM
authors.lastname: Ward
authors.forename: T P
authors.initials: TP
authors.lastname: Maus
authors.forename: H E
authors.initials: HE
authors.lastname: Wahlstrom
authors.forename: S B
authors.initials: SB
authors.lastname: Moore
authors.forename: R H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: R A
authors.initials: RA
authors.lastname: Krom
mesh_terms: D000241:Adenosine; D000328:Adult; D000493:Allopurinol; D002648:Child; D002758:Cholangiography; D005704:Gallbladder / Q000098:blood supply*; D005978:Glutathione; D006801:Humans; D006982:Hypertonic Solutions; D007328:Insulin; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D016031:Liver Transplantation; D009926:Organ Preservation / Q000009:adverse effects; D019188:Organ Preservation Solutions; D011183:Postoperative Complications / Q000209:etiology*; D011887:Raffinose; D012189:Retrospective Studies; D012307:Risk Factors; D012996:Solutions
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; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose