Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

doi:10.3748/wjg.v13.i20.2819

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May 28, 2007 (publication date) through Nov 27, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. May 28, 2007; 13(20): 2819-2825
Published online May 28, 2007. doi: 10.3748/wjg.v13.i20.2819

Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

Yogesh M Shastri, Nicolas M Hoepffner, Bora Akoglu, Christina Zapletal, Wolf O Bechstein, Wolfgang F Caspary, Dominik Faust

Yogesh M Shastri, Nicolas M Hoepffner, Bora Akoglu, Wolfgang F Caspary, Dominik Faust, Department of Medicine I, J.W. Goethe-University Hospital, Theodor-Stern-Kai 7, D - 60590 Frankfurt am Main, Germany

Christina Zapletal, Wolf O Bechstein, Department of Surgery, Theodor-Stern-Kai 7, D-60590, J.W. Goethe University Hospital, Frankfurt am Main, Germany

Author contributions: All authors contributed equally to the work.

Correspondence to: Dr. Dominik Faust, Medizinische Klinik I, J.W. Goethe-University Hospital, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany. d.faust@em.uni-frankfurt.de

Telephone: +49-69-63015212 Fax: +49-69-63014807

Received: March 1, 2007
Revised: March 20, 2007
Accepted: March 28, 2007
Published online: May 28, 2007

Abstract

AIM: To correlate the significance of liver biochemical tests in diagnosing post orthotopic liver transplantation (OLT) biliary complications and to study their profile before and after endoscopic therapy.

METHODS: Patients who developed biliary complications were analysed in detail for the clinical information, laboratory tests, treatment offered, response to it, follow up and outcomes. The profile of liver enzymes was determined. The safety, efficacy and outcomes of endoscopic retrograde cholangiography (ERC) were also analysed.

RESULTS: 40 patients required ERC for 70 biliary complications. GGT was found to be > 3 times (388.1 ± 70.9 U/mL vs 168.5 ± 34.2 U/L, P = 0.007) and SAP > 2 times (345.1 ± 59.1 U/L vs 152.7 ± 21.4 U/L, P = 0.003) the immediate post OLT values. Most frequent complication was isolated anastomotic strictures in 28 (40%). Sustained success was achieved in 26 (81%) patients.

CONCLUSION: Biliary complications still remain an important problem post OLT. SAP and GGT can be used as early, non-invasive markers for diagnosis and also to assess the adequacy of therapy. Endoscopic management is usually effective in treating the majority of these biliary complications.

Keywords: Liver biochemistry; Biliary lesion; Ischemic type biliary lesions; Endoscopic therapy; Orthotopic liver transplantation