title: The reduction rate of serum C3 following liver transplantation is an effective predictor of non-anastomotic strictures.
abstract: OBJECTIVE
  Non-anastomotic biliary strictures (NAS) are considered to be the thorniest complications following liver transplantation (LT). How to predict and adopt specific measures early to minimize the occurrence of it remains unclear. In this study, we aimed to find the relationship between the change rate of serum complement level and NAS.
  
  
  METHODS
  In a series of 232 adult patients who underwent their first LT, serum C3 and C4 concentrations at predetermined time points were collected. The correlation between the change rate of serum complement level following LT and the clinical outcome of NAS was retrospectively studied.
  
  
  RESULTS
  The reduction rate of serum C3 at the 1st day following LT in NAS patients was significantly different from that in non-NAS patients (p < 0.01). Receiver operating characteristic curve analysis demonstrated that the reduction rate of serum C3 is an effective predictor of NAS with an area under curve of 82.5 % (95 % CI 77.0-87.2 %). The reduction rate of C3 in the severe NAS group was significantly higher than that in the mild NAS group and the non-NAS group (p < 0.01).
  
  
  CONCLUSIONS
  Complement activation plays important roles on the progression of NAS. The reduction rate of serum C3 is an effective predictor of NAS.
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Shanghai, China. liushuang5805@hotmail.com.
authors.forename: Shuang
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Shanghai, China.
authors.forename: Tonghai
authors.initials: T
authors.lastname: Xing
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Shanghai, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Sheng
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Shanghai, China.
authors.forename: Shouwen
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Shanghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Shanghai, China. shzhihaipeng@hotmail.com.
authors.forename: Zhihai
authors.initials: Z
authors.lastname: Peng
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Shanghai, China. xingsun@hotmail.com.
authors.forename: Xing
authors.initials: X
authors.lastname: Sun
keywords: Biliary complications; Complement activation; Liver transplantation; Non-anastomotic strictures