Is early recurrence of hepatitis C associated with biliary anastomotic stricture after liver transplantation?
BACKGROUND
While the main effect of hepatitis C virus (HCV) is hepatitis, HCV is also known to cause a variety of systemic immunologic inflammatory abnormalities. The effect of HCV infection on the biliary tract after liver transplantation (LT) is not well understood. The aim of the current study is to determine if recurrence of hepatitis C affects biliary complications after LT, with special reference to late biliary anastomotic strictures (LBAS).


METHODS
A total of 688 consecutive adult LT recipients with a choledochocholedochostomy without T-tube placement between 1990 and 2005 were reviewed. Biliary anastomotic stricture was confirmed by endoscopic retrograde cholangiopancreatography. LBAS was defined as stricture that occurred 30 days or more after LT. Early HCV recurrence was defined as recurrence within 6 months after LT.


RESULTS
LBAS occurred in 55 patients (8% of total). Patients with HCV infection had a higher occurrence of LBAS than non-HCV patients (11% vs. 5%, P=0.0093). Among HCV patients, those with early HCV recurrence had an exceedingly high rate of LBAS (16%). In multivariate analyses, early recurrence of hepatitis C (P<0.0001), as well as occurrence of hepatic artery thrombosis (P=0.0018) and prolonged cold ischemic time (P=0.034), were independent risk factors affecting LBAS. Among HCV patients, those with LBAS had a significantly higher hepatitis activity index score (3.1 vs. 1.4, P<0.0001) and fibrosis stage (0.9 vs. 0.4, P<0.0001) as compared to patients without LBAS.


CONCLUSIONS
Patients with early recurrence of HCV have increased occurrence of late biliary anastomotic stricture after liver transplantation.
Fujita
Shiro
S
Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610-0286, USA. fujita@surgery.ufl.edu
Fujikawa
Takahisa
T
Mizuno
Shugo
S
Reed
Alan I
AI
Kim
Robin D
RD
Howard
Richard J
RJ
Firpi
Roberto J
RJ
Nelson
David R
DR
Hemming
Alan W
AW
D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D001663:Bilirubin / Q000097:blood; D015992:Body Mass Index; D002768:Choledochostomy / Q000009:adverse effects*; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D005705:Gallbladder Diseases / Q000601:surgery; D006526:Hepatitis C / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012044:Regression Analysis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
D001663:Bilirubin