title: Impact of non-anastomotic biliary strictures after liver transplantation on healthcare consumption, use of ionizing radiation and infectious events.
abstract: BACKGROUND
  Non-anastomotic biliary strictures (NAS) after orthotopic liver transplantation (OLT) have a negative influence on graft survival. Expert opinion suggests a negative effect of NAS on other important aspects of post-transplant care, although its impact is largely unknown as data are scarce.
  
  
  METHODS
  This retrospective single center study analyzed data on healthcare consumption, use of ionizing radiation, infectious complications and development of highly resistant microorganisms (HRMO) in adult patients with NAS. A comparison with a matched control group was made.
  
  
  RESULTS
  Forty-three liver recipients with NAS and 43 controls were included. Hospital admissions were higher in patients with NAS. Most common reason for admission was bacterial cholangitis (BC), with 70% of the patients having at least one episode compared to 9% in the control group. In patients with NAS, 67% received at least one ERCP compared to 21% in the control group (p = 0.001). This resulted in a larger yearly received radiation dose for patients with NAS (p = 0.001). Frequency of intravenous antibiotic therapy was higher (p = 0.001) for patients with NAS, consistently resulting in a higher number of cultures found with HRMO (p = 0.012).
  
  
  CONCLUSIONS
  NAS after OLT have a negative effect on post-transplant care, increasing readmission rates, interventional procedures, exposure to ionizing radiation, use of antibiotics, and development of HRMO.
authors.affiliation: Department of Gastroenterology and Hepatology, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: A Boudewijn
authors.initials: AB
authors.lastname: de Vries
authors.affiliation: Department of Gastroenterology and Hepatology, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Koornstra
authors.affiliation: Department of Microbiology, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Jerome R
authors.initials: JR
authors.lastname: Lo Ten Foe
authors.affiliation: Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
authors.affiliation: Department of Gastroenterology and Hepatology, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Aad P
authors.initials: AP
authors.lastname: van den Berg
authors.affiliation: Department of Gastroenterology and Hepatology, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Blokzijl
authors.affiliation: Department of Gastroenterology and Hepatology, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Verdonk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D001649:Bile Duct Diseases / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic; D018450:Disease Progression; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D006085:Graft Survival; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: biliary complications; health care consumption; highly resistant microorganisms; infectious complications; interventional procedures; ionizing radiation; ischemic type biliary lesions; liver transplantation