Clinical analysis of patients with ischemic type biliary lesions and portal hypertension after liver transplantation

doi:10.3877/cma.j.issn.2095-3232.2014.06.005

Abstract

Abstract:

Objective

To investigate the occurrence, development, treatments and prognosis of ischemic type biliary lesions (ITBL) complicated with portal hypertension after liver transplantation (LT).

Methods

Clinical data of 32 ITBL patients with portal hypertension after LT in Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University from January 2003 to April 2009 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. There were 28 males and 4 females with a mean age of (46±14) years old. The patients were followed up regularly and the occurrence, development, treatments and prognosis of portal hypertension were observed.

Results

When ITBL was diagnosed, mild splenomegaly was found in 11 cases, moderate splenomegaly in 14 cases and severe splenomegaly in 4 cases. Three cases were observed without splenomegaly. During the follow-up period, 5 cases were observed in stable states with mild splenomegaly or splenomegaly improving from moderate to mild. While for the other 27 cases, portal hypertension symptoms like splenomegaly etc. were observed becoming worse as ITBL developed including 11 cases with severe splenomegaly. Esophageal and gastric fundus varices were found in 53% (17/32) of the patients including 2 cases of lower esophagus mild varices, 8 cases of lower esophagus and gastric fundus mild to moderate varices, and 7 cases of moderate to severe varices. All the patients received intervention treatments via endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC). Liver retransplantation was performed in 11 cases, choledochojejunostomy in 4 cases and choledocholithiasis + biliary tract exploration in 1 case. Eighteen cases survived and 14 cases died. Four cases died of aggravating jaundice and liver failure, 4 liver cancer recurrence, 3 massive hemorrhage in upper gastrointestinal tract, and 1 severe infection, 1 multiple organ failure, 1 renal failure after liver retransplantation.

Conclusions

Most of ITBL patients with portal hypertension after LT gradually deteriorates with the progression of ITBL. The treatments mainly include intervention treatments, liver retransplantation, and choledochojejunostomy. The prognosis is very poor.

Key words: Liver transplantation, Biliary tract diseases, Hypertension, portal, Esophageal and gastric varices, Splenomegaly

Huimin Yi, Zaidong Zhang, Tong Zhang, Binsheng Fu, Yunhao Chen, Jie Ren, Wei Meng, Yang Yang, Shuhong Yi, Guihua Chen. Clinical analysis of patients with ischemic type biliary lesions and portal hypertension after liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2014, 03(06): 350-353.

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References 17

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