title: New diagnosis and therapy model for ischemic-type biliary lesions following liver transplantation--a retrospective cohort study.
abstract: Ischemic-type biliary lesions (ITBLs) are a major cause of graft loss and mortality after orthotopic liver transplantation (OLT). Impaired blood supply to the bile ducts may cause focal or extensive damage, resulting in intra- or extrahepatic bile duct strictures or dilatations that can be detected by ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and cholangiography. However, the radiographic changes occur at an advanced stage, after the optimal period for therapeutic intervention. Endoscopic retrograde cholangio-pancreatography (ERCP) and percutaneous transhepatic cholangiodrainage (PTCD) are the gold standard methods of detecting ITBLs, but these procedures cannot be used for continuous monitoring. Traditional methods of follow-up and diagnosis result in delayed diagnosis and treatment of ITBLs. Our center has used the early diagnosis and intervention model (EDIM) for the diagnosis and treatment of ITBLs since February 2008. This model mainly involves preventive medication to protect the epithelial cellular membrane of the bile ducts, regular testing of liver function, and weekly monitor of contrast-enhanced ultrasonography (CEUS) to detect ischemic changes to the bile ducts. If the liver enzyme levels become abnormal or CEUS shows low or no enhancement of the wall of the hilar bile duct during the arterial phase, early ERCP and PTCD are performed to confirm the diagnosis and to maintain biliary drainage. Compared with patients treated by the traditional model used prior to February 2008, patients in the EDIM group had a lower incidence of biliary tract infection (28.6% vs. 48.6%, P = 0.04), longer survival time of liver grafts (24±9.6 months vs. 17±12.3 months, P = 0.02), and better outcomes after treatment of ITBLs.
authors.affiliation: Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Ying-cai
authors.initials: YC
authors.lastname: Zhang
authors.affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: En-ze
authors.initials: EZ
authors.lastname: Qu
authors.affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Ren
authors.affiliation: Guangdong Provincial Key Laboratory of Liver Disease, Guangzhou, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Rong-qin
authors.initials: RQ
authors.lastname: Zheng
authors.affiliation: Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Gui-hua
authors.initials: GH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000465:Algorithms; D001649:Bile Duct Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007511:Ischemia / Q000150:complications*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D014463:Ultrasonography