Agnaldo Soares Lima1,2, Bárbara Buitrago Pereira3, Sven Jungmann4, Carla Jorge Machado5, Maria Isabel Toulson Davison Correia1,2. 1. Alfa Institute of Gastroenterology, Hospital das Clínicas, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. 2. Department of Surgery, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil. 3. Residence in Clinical Medicine, Hospital das Clínicas, UFMG, Belo Horizonte, MG, Brazil. 4. Founderslane, Health Berlin, Berlin, Germany. 5. Department of Preventive and Social Medicine, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazi.
Abstract
BACKGROUND: - Biliary complications (BC) represent the most frequent complication after liver transplantation, up to 34% of cases. AIM: To identify modifiable risk factors to biliary complications after liver transplantation, essential to decrease morbidity. METHOD: Clinical data, anatomical characteristics of recipient and donors, and transplant operation features of 306 transplants with full arterial patency were collected to identify risk factors associated with BC. RESULTS: BC occurred in 22.9% after 126 days (median) post-transplantation. In univariate analyses group 1 (without BC, n=236) and group 2 patients (with BC, n=70) did not differ on their general characteristics. BC were related to recipient age under 40y (p=0.029), CMV infection (p=0.021), biliary disease as transplant indication (p=0.018), lower pre-transplant INR (p=0.009), and bile duct diameter <3 mm (p=0.033). CMV infections occurred sooner in patients with postoperative biliary complications vs. control (p=0.07). In a multivariate analysis, only CMV infection, lower INR, and shorter bile duct diameter correlated with BC. Positive CMV antigenemia correlated with biliary complications, even when titers lied below the treatment threshold. CONCLUSIONS: Biliary complications after liver transplantation correlated with low recipient INR before operation, bile duct diameter <3 mm, and positive antigenemia for CMV or disease manifestation. As the only modifiable risk factor, routine preemptive CMV inhibition is suggested to diminish biliary morbidity after liver transplant.
BACKGROUND: - Biliary complications (BC) represent the most frequent complication after liver transplantation, up to 34% of cases. AIM: To identify modifiable risk factors to biliary complications after liver transplantation, essential to decrease morbidity. METHOD: Clinical data, anatomical characteristics of recipient and donors, and transplant operation features of 306 transplants with full arterial patency were collected to identify risk factors associated with BC. RESULTS: BC occurred in 22.9% after 126 days (median) post-transplantation. In univariate analyses group 1 (without BC, n=236) and group 2 patients (with BC, n=70) did not differ on their general characteristics. BC were related to recipient age under 40y (p=0.029), CMV infection (p=0.021), biliary disease as transplant indication (p=0.018), lower pre-transplant INR (p=0.009), and bile duct diameter <3 mm (p=0.033). CMV infections occurred sooner in patients with postoperative biliary complications vs. control (p=0.07). In a multivariate analysis, only CMV infection, lower INR, and shorter bile duct diameter correlated with BC. Positive CMV antigenemia correlated with biliary complications, even when titers lied below the treatment threshold. CONCLUSIONS: Biliary complications after liver transplantation correlated with low recipient INR before operation, bile duct diameter <3 mm, and positive antigenemia for CMV or disease manifestation. As the only modifiable risk factor, routine preemptive CMV inhibition is suggested to diminish biliary morbidity after liver transplant.
Authors: Lucas Ernani; Rodrigo Bronze de Martino; Wellington Andraus; Eduardo de Souza Martins Fernandes; Felipe Pedreira Tavares de Mello; Ronaldo Andrade; Leandro Savattone Pimentel; Luciana Bertocco de Paiva Haddad; Fabricio Ferreira Coelho; Paulo Herman; Luiz Augusto Carneiro D'Albuquerque Journal: Arq Bras Cir Dig Date: 2022-01-05
Authors: Lucas Ernani; Eduardo de Souza Martins Fernandes; Rodrigo Bronze de Martino; Fabricio Ferreira Coelho; Felipe Pedreira Tavares de Mello; Ronaldo Andrade; Leandro Savattone Pimentel; Luciana Bertocco de Paiva Haddad; Paulo Herman; Wellington Andraus; Luiz Augusto Carneiro D'Albuquerque Journal: Arq Bras Cir Dig Date: 2022-01-31