Медицинская литература. Новинки

 

 

 

 

 

 

Билиарные осложнения после трансплантации печени

Вы можете загрузить полный текст статьи в формате pdf

Цель. Выявление факторов риска билиарных осложнений после трансплантации печени. Материал и методы. С декабря 2011 г. по сентябрь 2017 г. 85 взрослым пациентам была выполнена трансплантация печени. От живого родственного донора трансплантация выполнена 68 (80%) взрослым пациентам, от посмертного донора - 17 (20%). Целая печень пересажена 17 (20%) реципиентам, правая доля от живого родственного донора - 60 (70,6%), левая доля - 7 (8,2%), задний латеральный сектор - 1 (1,2%). Результаты. Билиобилиарный анастомоз сформирован 76 (89,4%) реципиентам, у 13 (17,1%) из них развились билиарные осложнения. Двойной билиобилиарный анастомоз выполнен 5 (5,9%) пациентам, из них у 3 (60%) выявлены билиарные осложнения. Холангиоеюноанастомоз сформирован 2 (2,4%) пациентам, билиарных осложнений не отмечено. При комбинированной билиарной реконструкции (билиобилиарный анастомоз и холангиоеюноанастомоз) из 2 (2,4%) наблюдений в одном был диагностирован стеноз холангиоеюноанастомоза. Заключение. Предоперационные и интраоперационные исследования желчных протоков позволяют планировать вид билиарной реконструкции. Каркасное дренирование желчных протоков при билиобилиарном анастомозе уменьшает число билиарных осложнений.

Ключевые слова:
печень, трансплантация, донор, реципиент, билиарные осложнения, билиобилиарный анастомоз, холангиоеюноанастомоз, liver, transplantation, donor, recipient, biliary complication, duct-to-duct biliary anastomosis, cholangiojejunal anastomosis

Литература:
1.Yoshiya S., Shirabe K., Matsumoto Y., Ikeda T., Soejima Y., Yoshizumi T., Uchiyama H., Ikegami T., Harimoto N., Maehara Y. Rendezvous ductoplasty for biliary anastomotic stricture after living-donor liver transplantation. Transplantation. 2013; 95 (10): 1278-1283. https://doi.org/10.1097/TP.0b013e31828a9450
2.Попов А.Ю., Лищенко А.Н., Давыденко М.Н., Порханов В.А. Анализ осложнений после трансплатации печени. Вестник трансплантологии и искусственных органов. 2015; 17 (2): 107-110. https://doi.org/10.15825/1995-1191-2015-2-107-110
3.Полысалов В.Н., Руткин И.О., Боровик В.В., Жеребцов Ф.К., Гранов Д.А. Способ восстановления оттока желчи при ортотопической трансплантации печени с использованием пузырного протока. Вестник трансплантологии и искусственных органов. 2009; 11 (3): 51-55. https://doi.org/10.15825/1995-1191-2009-3-51-55
4.Roos F.J.M., Poley J.W., Polak W.G., Metselaar H.J. Biliary complications after liver transplantation; recent developments in etiology, diagnosis and endoscopic treatment. Best Pract. Res. Clin. Gastroenterol. 2017; 31 (2): 227-235. https://doi.org/10.1016/j.bpg.2017.04.002
5.Готье С.В., Мойсюк Я.Г., Попцов В.Н., Корнилов М.Н., Ярошенко Е.Б., Погребниченко И.В., Мойсюк Л.Я., Сушков А.И., Малиновская Ю.О., Цой Д.Л. Отдаленные результаты трансплантации трупной печени. Вестник трансплантологии и искусственных органов. 2014; 16 (3): 45-53. https://doi.org/10.15825/1995-1191-2014-3-45-53
6.Хубутия М.Ш., Чжао А.В., Шадрин К.Б Послеоперационные осложнения у реципиентов при трансплантации печени: современные представления о патогенезе и основных направлениях профилактики и лечения. Вестник трансплантологии и искусственных органов. 2009; 11 (2): 60-66. https://doi.org/10.15825/1995-1191-2009-2-60-66
7.Simoes P., Kesar V., Ahmad J. Spectrum of biliary complications following live donor liver transplantation. World J. Hepatology. 2015; 7 (14): 1856-1865. https://doi.org/10.4254/wjh.v7.i14.1856
8.Trotter J.F., Wachs M., Everson G.T., Kam I. Adult-to-adult transplantation of the right hepatic lobe from a living donor. N. Engl. J. Med. 2002; 346 (8): 1074-1082. https://doi.org/10.1056/NEJM200208223470817
9.Busutti R.W., Farmer D.G., Yersiz H., Hiatt J.R., McDiarmid S.V., Goldstein L.I., Saab S., Han S., Durazo F., Weaver M., Cao C., Chen T., Lipshutz G.S., Holt C., Gordon S., Gornbein J., Amersi F., Ghobrial R.M. Analysis of long-term outcomes of 3200 liver transplantations over two decades: a single-center experience. Ann. Surg. 2005; 241 (6): 905-918. https://doi.org/10.1097/01.sla.0000164077.77912.98
10.Verdonk R.C., Buis C.I., Porte R.J., van der Jagt E.J., Limburg A.J., van den Berg A.P., Slooff M.J., Peeters P.M., de Jong K.P., Kleibeuker J.H., Haagsma E.B. Anastomotic biliary strictures after liver transplantation: causes and consequences. Liver Transpl. 2006; 12 (5): 726-735. https://doi.org/10.1002/lt.20714
11.Koneru B., Sterling M.J., Bahramipour P.F. Bile duct strictures after liver transplantation: a changing landscape of the Achille’s heel. Liver Transpl. 2006; 12 (5): 702-704. https://doi.org/10.1002/lt.20753
12.Colonna J.O., Shaked A., Gomes A.S., Colquhoun S.D., Jurim O., McDiarmid S.V., Millis J.M., Goldstein L.I., Busuttil R.W. Biliary strictures complicating liver transplantation. Incidence, pathogenesis, management, and outcome. Ann. Surg. 1992; 216 (3): 344-350; discussion 350-352. https://doi.org/10.1097/00000658-199209000-00014
13.Heffron T.G., Emond J.C., Whitington P.F., Thistlethwaite J.R. Jr., Stevens L., Piper J., Whitington S., Broelsch C.E. Biliary complications in pediatric liver transplantation: a comparison of reduced-size and whole grafts. Transplantation. 1992; 53 (2): 391-395. PMID: 1738934.
14.Qian Y.B., Liu C.L., Lo C.M., Fan S.T. Risk factors for biliary reconstructions after liver transplantation. Arch. Surg. 2004; 139 (10): 1101-1105. https://doi.org/10.1001/archsurg.139.10.1101
15.Nakamura T., Tanaka K., Kiuchi T., Kasahara M., Oike F., Ueda M. Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases. Transplantation. 2002; 73 (12): 1896-1903. PMID: 12131684.
16.Grewal H.P., Shokouh-Amiri M.H., Vera S., Stratta R., Bagous W., Gaber A.O. Surgical technique for right lobe adult living donor liver transplantation without venovenous bypass or portocaval shunting and with duct-to-duct biliary reconstruction. Ann. Surg. 2001; 233 (4): 502-508. https://doi.org/10.1097/00000658-200104000-00004
17.Gondolesi G.E., Varotti G., Florman S.S., Munoz L., Fishbein T.M., Emre S.H., Schwartz M.E., Miller C. Biliary complications in 96 consecutive right lobe living donor transplant recipients. Transplantation. 2004; 77 (12): 1842-1848. https://doi.org/10.1097/01.TP.0000123077.78702.0C
18.Hsieh T.H., Mekeel K.L., Crowell M.D., Nguyen C.C., Das A., Aqel B.A., Carey E.J., Byrne T.J., Vargas H.E., Douglas D.D., Mulligan D.C., Harrison M.E. Endoscopic treatment of anastomotic biliary strictures after living donor liver transplantation: outcomes after maximal stent therapy. Gastrointest. Endosc. 2013; 77 (1): 47-54. https://doi.org/10.1016/j.gie.2012.08.034
19.Wang S.F., Huang Z.Y., Chen X.P. Biliary complications after living donor liver transplantation. Liver Transpl. 2011; 17 (10): 1127-1136. https://doi.org/10.1002/lt.22381
20.Lee K.W., Joh J.W., Kim S.J., Choi S.H., Heo J.S., Lee H.H., Park J.W., Lee S.K. High hilar dissection: new technique to reduce biliary complication in living donor liver transplantation. Liver Transpl. 2004; 10 (9): 1158-1162. https://doi.org/10.1002/lt.20230
21.Lo C.M., Fan S.T., Liu C.L., Lo R.J., Lau G.K., Wei W.I. Extending the limit on the size of adult recipient in living donor liver transplantation using extended right lobe graft. Transplantation. 1997; 63 (10): 1524-1528. PMID: 9175822.
22.Abdullah K., Abdeldayem H., Salama I.A., Badah K., Al-Somali B., Abdulkareem A. Retrospective analysis of the causes of rejection of potential donors for living related liver transplantation. Hepatol. Int. 2007; 1 (4): 431-436. https://doi.org/10.1007/s12072-007-9013-6
23.Lee S.-G. A complete treatment of adult living donor liver transplantation: a review of surgical technique and current challenges to expand indication of patients. Am. J. Transplant. 2015; 15 (1): 17-38. https://doi.org/10.1111/ajt.12907
24.Song G.W., Lee S.G., Hwang S., Sung G.B., Park K.M., Kim K.H., Ahn C.S., Moon D.B., Ha T.Y., Kim B.S., Moon K.M., Jung D.H. Preoperative evaluation of biliary anatomy of donor in living donor liver transplantation by conventional nonenhanced magnetic resonance cholangiography. Transpl. Int. 2007; 20 (2): 167-173. https://doi.org/10.1111/j.1432-2277.2006.00419.x
25.Lo C.M. Expanding living donor liver transplantation. Liver Transpl. 2016; 22 (S1): 37-39. https://doi.org/10.1002/lt.24618
26.Yazumi S., Chiba T. Biliary complications after a right-lobe living donor liver transplantation. J. Gastroenterol. 2005; 40 (9): 861-865. https://doi.org/10.1007/s00535-005-1698-5
27.Chang J.H., Lee I.S., Chun H.J., Choi J.Y., Yoon S.K., Kim D.G., You Y.K., Choi M.G., Han S.W. Comparative study of rendezvous techniques in post-liver transplant biliary stricture. World J. Gastroenterol. 2012; 18 (41): 5957-5964. https://doi.org/10.3748/wjg.v18.i41.5957
28.Bauschke A., Altendorf-Hofmann A., Malessa C., Rohland O., Settmacher U. Einfluss der Gallengangsanatomie auf biliare Komplikationen bei Lebendspenden des rechten Leberlappens. Der Chirurg. 2017; 89 (3): 222-228. https://doi.org/10.1007/s00104-017-0514-0
29.Pagano D., Cintorino D., Li P.S., Paci M., Tropea A., Ricotta C., Bonsignore P., Saffioti M.C., Spada M., Miraglia R., Gridelli B.G., Gruttadauria S. Intra-operative contrast cholangio graphy in living donor liver transplantation: The ISMETT experience. Transplant. Proc. 2015; 47 (7): 2159-2160. https://doi.org/10.1016/j.transproceed.2014.11.069
30.Gao F., Xu X., Zhu Y.B., Wei Q., Zhou B., Shen X.Y., Ling Q., Xie H.Y., Wu J., Wang W.L., Zheng S.S. Impact of intraoperative cholangiography and parenchymal resection to donor liver function in living donor liver transplantation. Hepatobiliary Pancreat. Dis. Int. 2014; 13 (3): 259-263. PMID: 24919608.
31.Jeng K.S., Huang C.C., Lin C.K., Lin C.C., Chen K.H., Chu S.H. Repeated introperative cholangiography is helpful for donor safety in the procurement of right liver graft with supraportal right bile duct variants in living-donor liver transplantation. Transplant. Proc. 2014; 46 (3): 686-688. https://doi.org/10.1016/j.transproceed.2013.11.093
32.Ragab A., Lopez-Soler R.I., Oto A., Testa G. Correlation between 3D-MRCP and intra-operative findings in right liver donors. Hepatobiliary Surg. Nutr. 2013; 2 (1): 7-13. https://doi.org/10.3978/j.issn.2304-3881.2012.11.01
33.Marubashi S., Dono K., Nagano H., Kobayashi S., Takeda Y., Umeshita K., Monden M., Doki Y., Mo M. Biliary reconstruction in living donor liver transplantation: technical invention and risk factor analysis for anastomotic stricture. Transplantation. 2009; 88 (9): 1123-1130. https://doi.org/10.1097/TP.0b013e3181ba184a
34.Yaprak O., Dayangac M., Akyildiz M., Demirbas T., Guler N., Bulutcu F., Bassullu N., Akun E., Yuzer Y., Tokat Y. Biliary complications after right lobe living donor liver transplantation: a single-centre experience. HPB (Oxford). 2012; 14 (1): 49-53. https://doi.org/10.1111/j.1477-2574.2011.00401.x
35.Shaha S.A., Granta D.R., McGilvraya I.D., Greiga P.D., Selznera M., Lillyb L.B., Girgrahb N., Levyb G.A., Cattrala M.S. Biliary strictures in 130 consecutive right lobe living donor liver transplant recipients: results of a western center. Am. J. Transplant. 2007; 7: 161-167. https://doi.org/10.1111/j.1600-6143.2006.01601.x
36.Azzam A.Z., Tanaka K. Biliary complications after living donor liver transplantation: A retrospective analysis of the Kyoto experience 1999-2004. Indian J. Gastroenterol. 2017; 36 (4): 296-304. https://doi.org/10.1007/s12664-017-0771-3
37.Chan S.C., Fan S.T. Biliary complications in liver transplantation. Hepatol. Int. 2008; 2 (4): 399-404. https://doi.org/10.1007/s12072-008-9092-z
38.Kasahara M., Egawa H., Takada Y., Oike F., Sakamoto S., Kiuchi T. Biliary reconstruction in right lobe living-donor liver transplantation comparison of different techniques in 321 recipients. Ann. Surg. 2006; 243 (4): 559-566. https://doi.org/10.1097/01.sla.0000206419.65678.2e
39.Wojcicki M., Milkiewicz P., Silva M. Biliary tract compli cations after liver transplantation: a review. Dig. Surg. 2008; 25 (4): 245-257. https://doi.org/10.1159/000144653
40.Семенков А.В., Ким Э.Ф., Филин А.В., Бурмистров Д.С., Метелин А.В., Камалов Ю.Р., Галян Т.Н., Гончарова А.В. Целесообразность каркасного дренирования при реконструкции желчеотведения фрагментарных трансплантатов печени. Хирургия. Журнал им. Н.И. Пирогова. 2016; 9: 4-12. https://doi.org/10.17116/hirurgia201694-12
41.Shah J.N., Ahmad N.A., Shetty K., Kochman M.L., Long W.B., Brensinger C.M., et al. Endoscopic management of biliary complications after adult living donor liver transplantation. Am. J. Gastroenterol. 2004; 99 (7): 1291-1295. https://doi.org/10.1111/j.1572-0241.2004.30775.x
42.Egawa H., Inomata Y., Uemoto S., Asonuma K., Kiuchi T., Fujita S. Biliary anastomotic complications in 400 living related liver transplantations. World J. Surg. 2001; 25 (10): 1300-1307. https://doi.org/10.1007/s00268-001-0114-4
43.Cheng Y.F., Chen C.L., Chen Y.S., Huang T.L., Chen T.Y., Lee T.Y. Interventional radiology in the treatment of post-liver transplant complications. Transplant. Proc. 2000; 32 (7): 2196-2197. PMID: 11120130.
44.Chang J.H., Lee I., Choi M.G., Han S.W. Current diagnosis and treatment of benign biliary strictures after living donor liver transplantation. World J.Gastroenterol. 2016; 22 (4): 1593-1606. https://doi.org/10.3748/wjg.v22.i4.1593
45.Kawano Y., Mizuta K., Hishikawa S., Egami S., Fujiwara T., Hyodo M., Yasuda Y., Yano T., Nakazawa K., Yamamoto H. Rendezvous penetration method using double-balloon endoscopy for complete anastomosis obstruction of hepaticojejunostomy after pediatric living donor liver transplantation. Liver Transpl. 2008; 14 (3): 385-387. https://doi.org/10.1002/lt.21357
46.Zhang S., Zhang M., Xia Q., Zhang J.J. Biliary reconstruction and complications in adult living donor liver transplantation: systematic review and meta-analysis. Тransplant. Proc. 2014; 46 (1): 208-215. https://doi.org/10.1016/j.transproceed.2013.05.014

Biliary complications after liver transplantation

Aim. To identify the risk factors for biliary complications after liver transplantation. Materials and methods. From December 2011 to September 2017, 85 adult patients underwent liver transplantation. Living donor liver transplantation was performed in 68 (80%) patients, deceased donor liver transplantation was performed in 17 (20%). Whole liver transplantation was performed in 17 (20%), right liver lobe transplantation - 60 (70.6%), left liver lobe - 7 (8.2%), posterior-lateral sector - 1 (1.2%). Results. Duct to duct anastomosis was performed in 76 (89.4%) recipients, 13 (17.1%) of them developed biliary complications. Double duct-to-duct anastomosis was performed in 5 (5.9%); biliary complications occurred in 3 (60%) of them. Cholangiojejunal biliary Roux-en-Y anastomosis was performed in 2 (2.4%) patients, there were no complications. Combined biliary reconstruction (Duct-to-duct and cholangiojejunal biliary Roux-en-Y anastomosis) was performed in 2 (2.4%), of which 1 (50%) had a stricture of cholangiojejunostomy. Conclusion. Preoperative and intraoperative examinations of the bile ducts contribute to plan the type of biliary reconstruction. Biliary splinting in duct-to-duct anastomosis reduces the incidence of biliary complications.

Keywords:
печень, трансплантация, донор, реципиент, билиарные осложнения, билиобилиарный анастомоз, холангиоеюноанастомоз, liver, transplantation, donor, recipient, biliary complication, duct-to-duct biliary anastomosis, cholangiojejunal anastomosis