title: Risk factors for and management of ischemic-type biliary lesions following orthotopic liver transplantation: A single center experience.
abstract: BACKGROUND
  Biliary complications can cause morbidity, graft loss, and mortality after liver transplantation. The most troublesome biliary complications are ischemic-type biliary lesions (ITBL), which occur since transplants can now be performed after the donor has undergone circulatory death. The exact origin of this type of biliary complication remains unknown.
  
  
  METHODS
  A total of 528 patients were retrospectively analyzed following liver transplantation after excluding 30 patients with primary sclerosing cholangitis and those lost to follow-up from January 2007 to January 2014. The incidence of and risk factors for ITBL were evaluated.
  
  
  RESULTS
  Cold ischemia time (CIT) (P = 0.042) and warm ischemia time (WIT) (P = 0.006) were found to be independent risk factors for the development of ITBL. Use of the cytochrome P450 (CYP) 3A5 genotype assay to guide individualization of immunosuppressive medications resulted in significantly fewer ITBL (P = 0.027. Autoimmune hepatitis might be a risk factor for ITBL, as determined using univariate analysis (P = 0.047).
  
  
  CONCLUSIONS
  Efforts should be taken to minimize risk factors associated with ITBL, such as CIT and WIT. The CYP3A5 genotype assay should be used to guide selection of immunosuppressive therapy in an effort to reduce the occurrence of ITBL.
authors.affiliation: Department of Hepatobiliary Surgery and You-An Liver Transplant Center, Beijing You-An Hospital, Capital Medical University, Beijing, P.R. China.
authors.forename: Tao
authors.initials: T
authors.lastname: Jiang
authors.affiliation: Department of Hepatobiliary Surgery and You-An Liver Transplant Center, Beijing You-An Hospital, Capital Medical University, Beijing, P.R. China.
authors.forename: Chuanyun
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Hepatobiliary Surgery and You-An Liver Transplant Center, Beijing You-An Hospital, Capital Medical University, Beijing, P.R. China.
authors.forename: Binwei
authors.initials: B
authors.lastname: Duan
authors.affiliation: Department of Hepatobiliary Surgery and You-An Liver Transplant Center, Beijing You-An Hospital, Capital Medical University, Beijing, P.R. China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Hepatobiliary Surgery and You-An Liver Transplant Center, Beijing You-An Hospital, Capital Medical University, Beijing, P.R. China.
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.affiliation: Institute & Hospital of Hepatobiliary Surgery, Key Laboratory of Digital Hepatobiliary Surgery of Chinese PLA, Chinese PLA Medical School.
authors.forename: Shichun
authors.initials: S
authors.lastname: Lu
mesh_terms: D000328:Adult; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D002681:China; D050377:Cold Ischemia / Q000009:adverse effects; D051544:Cytochrome P-450 CYP3A / Q000235:genetics / Q000378:metabolism; D005838:Genotype; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000493:pharmacokinetics; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D052096:Warm Ischemia / Q000009:adverse effects
chemical_list: D007166:Immunosuppressive Agents; C510164:CYP3A5 protein, human; D051544:Cytochrome P-450 CYP3A