title: Aetiology and risk factors of ischaemic cholangiopathy after liver transplantation.
abstract: Liver transplantation (LT) is the best treatment for end-stage hepatic failure, with an excellent survival rates over the last decade. Biliary complications after LT pose a major challenge especially with the increasing number of procured organs after circulatory death. Ischaemic cholangiopathy (IC) is a set of disorders characterized by multiple diffuse strictures affecting the graft biliary system in the absence of hepatic artery thrombosis or stenosis. It commonly presents with cholestasis and cholangitis resulting in higher readmission rates, longer length of stay, repeated therapeutic interventions, and eventually re-transplantation with consequent effects on the patient's quality of life and increased health care costs. The pathogenesis of IC is unclear and exhibits a higher prevalence with prolonged ischaemia time, donation after circulatory death (DCD), rejection, and cytomegalovirus infection. The majority of IC occurs within 12 mo after LT. Prolonged warm ischaemic times predispose to a profound injury with a subsequently higher prevalence of IC. Biliary complications and IC rates are between 16% and 29% in DCD grafts compared to between 3% and 17% in donation after brain death (DBD) grafts. The majority of ischaemic biliary lesions occur within 30 d in DCD compared to 90 d in DBD grafts following transplantation. However, there are many other risk factors for IC that should be considered. The benefits of DCD in expanding the donor pool are hindered by the higher incidence of IC with increased rates of re-transplantation. Careful donor selection and procurement might help to optimize the utilization of DCD grafts.
authors.affiliation: Moustafa Mabrouk Mourad, Abdullah Algarni, Christos Liossis, Simon R Bramhall, Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
authors.forename: Moustafa Mabrouk
authors.initials: MM
authors.lastname: Mourad
authors.affiliation: Moustafa Mabrouk Mourad, Abdullah Algarni, Christos Liossis, Simon R Bramhall, Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Algarni
authors.affiliation: Moustafa Mabrouk Mourad, Abdullah Algarni, Christos Liossis, Simon R Bramhall, Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
authors.forename: Christos
authors.initials: C
authors.lastname: Liossis
authors.affiliation: Moustafa Mabrouk Mourad, Abdullah Algarni, Christos Liossis, Simon R Bramhall, Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
authors.forename: Simon R
authors.initials: SR
authors.lastname: Bramhall
mesh_terms: D001649:Bile Duct Diseases / Q000209:etiology; D001659:Biliary Tract / Q000503:physiopathology*; D001926:Brain Death; D058625:End Stage Liver Disease / Q000150:complications* / Q000628:therapy*; D006085:Graft Survival; D006801:Humans; D008107:Liver Diseases / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D010359:Patient Readmission; D011788:Quality of Life; D015427:Reperfusion Injury; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000009:adverse effects
keywords: Biliary complications; Cold ischaemia time; Donation after circulatory death; Ischaemic cholangiopathy; Orthotopic liver transplantation; Reperfusion injury