Graft cholangiopathy: etiology, diagnosis, and therapeutic strategies.
BACKGROUND
Graft cholangiopathy has been recognized as a significant cause of morbidity, graft loss, and even mortality in patients after orthotopic liver transplantation. The aim of this review is to analyze the etiology, pathogenesis, diagnosis and therapeutic strategies of graft cholangiopathy after liver transplantation.


METHODS
A PubMed database search was performed to identify articles relevant to liver transplantation, biliary complications and cholangiopathy.


RESULTS
Several risk factors for graft cholangiopathy after liver transplantation have been identified, including ischemia/reperfusion injury, cytomegalovirus infection, immunological injury and bile salt toxicity. A number of strategies have been attempted to prevent the development of graft cholangiopathy, but their efficacy needs to be evaluated in large clinical studies. Non-surgical approaches may offer good results in patients with extrahepatic lesions. For most patients with complex hilar and intrahepatic biliary abnormalities, however, surgical repair or re-transplantation may be required.


CONCLUSIONS
The pathogenesis of graft cholangiopathy after liver transplantation is multifactorial. In the future, more efforts should be devoted to the development of more effective preventative and therapeutic strategies against graft cholangiopathy.
Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China. dongjh301@163.com.
Ying
Y
Luo
Wen-Bin
WB
Ji
Wei-Dong
WD
Duan
Sheng
S
Ye
Jia-Hong
JH
Dong
D001647:Bile Acids and Salts / Q000633:toxicity; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D001652:Bile Ducts / Q000293:injuries / Q000473:pathology* / Q000503:physiopathology*; D003586:Cytomegalovirus Infections / Q000150:complications; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects*; D015427:Reperfusion Injury / Q000150:complications; D012307:Risk Factors
D001647:Bile Acids and Salts; D007155:Immunologic Factors