title: Immunological risk factors in biliary strictures after liver transplantation.
abstract: BACKGROUND
  The purpose of this study was to investigate immunological risk factors associated with BS (Biliary Strictures) after LT (Liver Transplantation).
  
  
  METHODS
  The study included 192 patients out of 273 adult liver transplantations performed from August 2005 to December 2012, with a radiological or surgically proven biliary stricture. About 35 potential risk factors for biliary strictures were studied. Results A biliary stricture was diagnosed in 22.9% of transplants; the anastomotic type and the non-anastomotic type complicated the transplantation in 18.2% and 7.8% of cases, respectively. Six patients (3.1%) presented both of forms. Univariate analysis using logistic regression showed that preoperative serum bilirubin level >2 mg/dl (P=0.040), donor age >46 years old (P=0.007), positive crossmatch (P=0.007), product of donor age and preoperative Model for End Stage Liver Disease (DMELD) >710 (P=0.011), occurrence of acute or chronic rejection (P=0.004; P=0.003), and biliary leak (P=0.002) were all significantly associated with the development of biliary stricture. At the multivariate analysis, Primary Biliary Cirrhosis (PBC) (P=0.019), donor age >46 years (P=0.008), crossmatch positivity (P=0.001), and acute or chronic rejection (P=0.005; P=0.043) appeared to be the only variables independently associated with the development of a biliary stricture. Conclusions Immunological risk factors (PBC, crossmatch positivity, acute and chronic rejection) emerged as being the most important variables associated to the development of biliary strictures after LT.
authors.affiliation: Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Mocchegiani
authors.affiliation: Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vincenzi
authors.affiliation: Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Lanari
authors.affiliation: Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Montalti
authors.affiliation: Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Nicolini
authors.affiliation: Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Svegliati Baroni
authors.affiliation: Department of Surgery and Transplantation, University of Udine, Udine, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Risaliti
authors.affiliation: Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000097:blood / Q000209:etiology* / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000276:immunology*; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001663:Bilirubin