Gallengangskomplikationen und Gallengangsanastomosenstenosen nach orthotopen Lebertransplantationen - Retrospektive Untersuchung von 220 Lebertransplantationen der Universitätsmedizin Göttingen

Strictures of biliary anastomosis after orthotopic liver transplantation – Incidence and Risk factors

Biliary complications and strictures of biliary anastomosis after orthotopic liver transplantation - retrospective study of 220 liver transplants at the University Medical Center Göttingen

by Michael Sobotta
Doctoral thesis
Date of Examination:2016-02-17
Date of issue:2016-02-17
Advisor:Prof. Dr. Harald Schwörer
Referee:Prof. Dr. Harald Schwörer
Referee:Prof. Dr. Annegret Müller-Dornieden
Persistent Address: http://dx.doi.org/10.53846/goediss-5517

 

 

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Abstract

English

Objective: Over 40y passed since the first liver transplantation has been performed. After the development of the immunosuppressant Cyclosporin A significant increase in the survival rates up to 60-70% could be achieved. Despite the progress in pharmacological treatment as well as surgical and medical care, biliary complications are the most common, in particular strictures. Several different risk factors for biliary strictures have been reported such as bile leakage, gender mismatch, stay in intensive care unit (ICU-time), cold and warm ischemic time, duration of surgery, hepatic artery thrombosis as well as vascular insufficiencies and cytomegalovirus infection. The purpose of this study was to evaluate the incidence of strictures of biliary anastomosis in our hospital as well to confirm those previously published risk factors and identify further influences on the genesis of biliary strictures. Patients and Methods: Using patient records including radiological and endoscopic findings a retrospective analysis of 220 cases of liver transplantation was performed. The follow-up was performed in all cases for over 12 months after the transplantation. Several possible risk factors associated with developing a biliary anastomotic stricture were defined and analysed. They included donor data as well pre-, peri- and postoperative recipient data. Furthermore the preoperative and postoperative pharmacotherapy including the concomitant medication, antibiotics, catecholamines and immunosuppressants were evaluated to examine them as potential risk factors. Results: Strictures of the biliary anastomosis were found in 74 of 220 (33,6%) cases of liver transplantions. The comorbidities diabetes mellitus II (p=0,0014) and arterial hypertension (p=0,0468), a pharmacotherapy with beta receptor blocker (ß-Blocker; p=0,0122), angiotensin-converting-enzyme inhibitors (ACE-Inhibitors; p=0,0011) and calcium antagonists (p=0,0040) and postoperative mechanic ventilation time (ITN-time; p=0,0390) were detected to be associated with a significantly increased risk of developing biliary anastomotic strictures after orthotope liver transplantation. Conclusions: This study confirms previous findings stating strictures of biliary anastomosis as a common complication after liver transplantation. It also shows further risk factors and implicates a great need for further studies evaluating the influence of concomitant pharmacotherapy on the incidence of strictures of the biliary anastomosis and biliary complications overall.
Keywords: liver transplantation, biliary complications, biliary strictures, concomitant pharmacotherapy
 
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