Classification and prognosis of intrahepatic biliary stricture after liver transplantation.
Intrahepatic biliary stricture (IHBS) after liver transplantation (LT) may develop in patients with hepatic artery thrombosis, chronic rejection, or ABO incompatibility, as well as in patients with prolonged warm ischemia in non-heart-beating donor (NHBD) LT. However, the clinical course and methods of management have not been well defined for IHBSs to date. Thus, the purpose of this study was to provide a classification of post-LT IHBS and to investigate patient prognosis. Forty-four patients who developed IHBS after NHBD LT were enrolled. On the basis of the cholangiographic appearance, patients were classified into 4 groups: unilateral focal (UF, n=8), confluence (CO, n=10), bilateral multifocal (BM, n=21), and diffuse necrosis (DN, n=5). The UF type was defined as cases with stricture only in the segmental branch of the unilateral hemiliver; the CO type in cases with several strictures at confluence level; and the BM type in cases with multiple strictures bilaterally. Cases with diffuse obliteration of peripheral ducts or destruction of the central architectural integrity, over a long segment, were classified as the DN type. Five patients with the CO type required several interventions requiring biliary dilatation, yet all patients with the UF or CO type had a good prognosis. Among the patients with the BM type, 3 patients (14.3%) died or underwent retransplantation due to biliary complications, and 7 (33.3%) required repeated interventions for >1 year without improvement. Moreover, among 5 patients classified as the DN type, 1 (20%) died of biliary sepsis, 2 (40%) underwent retransplantation, and the remaining 2 (40%) did not recover from persistent jaundice and life-threatening cholangitis despite multiple interventions. In conclusion, all patients classified as UF or CO had a good outcome with or without additional interventions. However, all patients with the DN type and about half the patients with the BM type did not recover from life-threatening complications, despite repeated aggressive interventions; early retransplantation was therefore the only treatment option for these patients.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Hae Won
HW
Lee
Kyung-Suk
KS
Suh
Woo Young
WY
Shin
Eung-Ho
EH
Cho
Nam-Joon
NJ
Yi
Jeong Min
JM
Lee
Joon Koo
JK
Han
Kuhn Uk
KU
Lee
D001649:Bile Duct Diseases / Q000145:classification* / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology*; D002758:Cholangiography; D003251:Constriction, Pathologic; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D009626:Terminology as Topic; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome