Predictors of endoscopic treatment outcome in the management of biliary complications after orthotopic liver transplantation. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Faleschini, Giacomo; Vadalà di Prampero, Salvatore F.; Bulajic, Milutin; Baccarani, Umberto; Toniutto, Pierluigi; Panic, Nikola; Zoratti, Loris M.; Marino, Marco; Zilli, Maurizio
• Is Part Of: European journal of gastroenterology & hepatology. Volume 27:Issue 2(2015:Feb.)
• Publication Date: 2015-02
• Subjects: Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000000251
• Languages: English
• ISSNs: 0954-691X

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background and aims</title> <p>The most common complications after liver transplantation nowadays affect the biliary tract.</p> <p>We carried out a retrospective study to identify predictors of endoscopic treatment outcome in the management of post-transplantation biliary complications.</p> </sec> <sec> <title>Methods</title> <p>Data from all patients with post-transplantation biliary complications subjected to endoscopic treatment at the University of Udine between 2000 and 2012 were extracted. To identify predictors of endoscopic treatment outcome, a logistic regression analysis was carried out. Cox modeling was used to identify factors associated with mortality.</p> </sec> <sec> <title>Results</title> <p>We identified 142 patients who developed biliary complications: 83 of these patients had a successful endoscopic therapy, whereas 45 had a failure. Fourteen patients, who developed nonanastomotic biliary stricture, were excluded from the analysis. Patients with biliary complications who had pretransplant Model for End-Stage Liver Disease score more than 10 [odds ratio (OR) 3.88; 95% confidence interval (CI) 1.16–12.95; <italic>P</italic>=0.03] and stent retention time more than 12 months (OR 6.45; 95% CI 2.14–19.42; <italic>P</italic><0.01) were less likely to respond to endoscopic therapy. In contrast, both dilatation and stenting procedures (OR 0.10; 95% CI 0.03–0.30; <italic>P</italic><0.01) and 10 Fr diameter stent placement (OR 0.21; 95% CI 0.07–0.70; <italic>P</italic>=0.01) predicted favorable endoscopic treatment outcome. Time to the occurrence of biliary complications of more than 3 months [hazard ratio (HR) 0.24; 95% CI 0.10–0.56] and placement of five or more stents (HR 0.31; 95% CI 0.12–0.79) were found to be protective against mortality, whereas hepatic artery thrombosis was a significant risk factor for mortality (HR 13.88; 95% CI 4.08–47.25).</p> </sec> <sec> <title>Conclusion</title> <p>We found endoscopic treatment to be less effective in patients with pretransplant Model for End-Stage Liver Disease score more than 10 and stent retention time more than 12, whereas dilatation and stenting procedure and 10 Fr diameter stent placement predicted a favorable outcome.</p> </sec> </abstract>