Biliary complications in liver transplantation: Impact of anastomotic technique and ischemic time on short- and long-term outcome

AIM: To elucidate the impact of various donor recipient and transplant factors on the development of biliary complications after liver transplantation.METHODS: We retrospectively reviewed 200 patients of our newly established liver transplantation(LT) program, who received full size liver graft. Biliary reconstruction was performed by side-to-side(SS), end-to-end(EE) anastomosis or hepeaticojejunostomy(HJ). Biliary complications(BC), anastomotic stenosis, bile leak, papillary stenosis, biliary drain complication, ischemic type biliary lesion(ITBL) were evaluated by studying patient records, corresponding radiologic imaging and reports of interventional procedures [e.g., endoscopic retrograde cholangiopancreatography(ERCP)]. Laboratory results included alanine aminotransferase(ALT), gammaglutamyltransferase and direct/indirect bilirubin with focus on the first and fifth postoperative day, six weeks after LT. The routinely employed external bile drain was examined by a routine cholangiography on the fifth postoperative day and six weeks after transplantation as a standard procedure, but also whenever clinically indicated. If necessary, interventional(e.g., ERCP) or surgical therapy was performed. In case of biliary complication, patients were selected, assigned to different complication-groups and subsequently reviewed in detail. To evaluate the patients outcome, we focussed on appearance of postoperative/post-interventional cholangitis, need for rehospitalisation, retransplantation, ITBL or death caused by BC.RESULTS: A total of 200 patients [age: 56(19-72), alcoholic cirrhosis: n = 64(32%), hepatocellular carcinoma: n = 40(20%), acute liver failure: n = 23(11.5%), cryptogenic cirrhosis: n = 22(11%), hepatitis B virus /hepatitis C virus cirrhosis: n = 13(6.5%), primary sclerosing cholangitis: n = 13(6.5%), others: n = 25(12.5%) were included. The median follow-up was 27 mo until June 2015. The overall biliary complication rate was 37.5%(n = 75) with anastomotic strictures(AS): n = 38(19%), bile leak(BL): n = 12(6%), biliary drain complication: n = 12(6%); papillary stenosis(PS): n = 7(3.5%), ITBL: n = 6(3%). Clinically relevant were only 19%(n = 38). We established a comprehensive classification for AS with four grades according to clinical relevance. The reconstruction techniques [SS: n = 164, EE: n = 18, HJ: n = 18] showed no significant impact on the development of BCs in general(all n 0.05), whereas in the HJ group significantly less AS were found(P = 0.031). The length of donor intensive care unit stay over 6 d had a significant influence on BC development(P = 0.007, HR = 2.85; 95%CI: 1.33-6.08) in the binary logistic regression model, whereas other reviewed variables had not [warm ischemic time 45 min(P = 0.543), cold ischemic time 10 h(P = 0.114), ALT init 1500 U/L(P = 0.631), bilirubin init 5 mg/d L(P = 0.595), donor age 65(P = 0.244), donor sex(P = 0.068), rescue organ(P = 0.971)]. 13%(n = 10) of BCs had no therapeutic consequences, 36%(n = 27) resulted in repeated lab control, 40%(n = 30) received ERCP and 11%(n = 8) surgical therapy. Fifteen(7.5%) patients developed cholangitis [AS(n = 6), ITBL(n = 5), PS(n = 3), biliary lesion BL(n = 1)]. One patient developed ITBL twelve months after LT and subsequently needed retransplantation. Rehospitalisation rate was 10.5 %(n = 21) [AS(n = 11), ITBL(n = 5), PS(n = 3), BL(n = 1)] with intervention or reinterventional therapy as main reasons. Retransplantation was performed in 5(2.5%) patients [ITBL(n = 1), acute liver injury(ALI) by organ rejection(n = 3), ALI by occlusion of hepatic artery(n = 1)]. In total 21(10.5%) patients died within the follow-up period. Out of these, one patient with AS developed severe fatal chologenic sepsis after ERCP.CONCLUSION: In our data biliary reconstruction technique and ischemic times seem to have little impact on the development of BCs.     

Prognostic value of 18F‐fluorodeoxyglucose positron emission tomography/computed tomography in patients with cutaneous angiosarcoma: A retrospective study of 18 cases

Cutaneous angiosarcoma (CAS) is a rare soft tissue sarcoma with rapid growth and poor prognosis. We retrospectively analyzed the data of 18 patients with CAS who underwent ¹⁸F‐Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) at the initial visit to the Department of Dermatology, Okayama University Hospital from September 2006 to March 2016. In the univariate survival analysis, patients with high standardized uptake values (SUV_max) of the primary tumor showed significantly poorer prognosis than those with low SUV_max. Early assessment of prognosis using PET/CT may predict patient survival and is useful in the selection of therapeutic strategies.     

儿童颞骨骨折临床特点和治疗策略

目的 探讨儿童颞骨骨折的临床特点及治疗策略.方法 回顾性分析2014年7月～2021年7月首都医科大学附属北京儿童医院确诊的477例18岁以下颞骨骨折患儿的临床资料,包括患儿性别、年龄、受伤原因、影像学、面神经及听力学评估、并发症、治疗及预后.结果 477例颞骨骨折患儿中男358例、女119例,男女比例为3∶1,年龄范...     

燃煤氟砷致骨代谢损伤的生物暴露限值初探

目的 探讨燃煤氟砷致暴露人群骨代谢损伤的生物暴露限值(BEL).方法 2009年选择贵州省清镇市流长乡198例氟砷联合暴露者作为调查对象,分别检测尿氟、尿砷及骨代谢效应标志尿羟脯氨酸(UHYP)和尿Ⅰ型胶原交联氨基末端肽(UNTX)、骨强度指数(STI).应用BMDS Version 2.1软件计算燃煤氟砷致骨代谢损伤的尿氟、尿砷基准剂量(BMD)及其可信限下限(BMDL).结果 氟、砷混合暴露引起骨代谢损伤的尿氟BMD及BMDL范围分别为0.68 ～ 1.35 mg/g Cr和0.57 ～ 1.11 mg/g Cr;尿砷BMD及BMDL范围分别为8.36 ～ 18.77 μg/g Cr和7.12 ～ 15.40 μg/g Cr.结论 建议燃煤氟砷混合暴露引起骨代谢损伤的生物暴露限值,尿氟为0.57 mg/g Cr,尿砷为7.12 μg/g Cr.     

Why women may live longer than men do? A telomere-length regulated and diet-based entropic assessment

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MSCTA对下肢动脉硬化闭塞症的应用价值

目的通过比较各种MSCTA后处理技术,探讨MSCTA对下肢动脉硬化闭塞症诊断的应用价值。方法对73例下肢动脉硬化闭塞症患者MSCTA检查结果进行MIP、MPR、CPR、VR重组,对比动脉清晰度、管壁钙化、支架显示、病变狭窄段及下肢动脉栓子的检出。对成像方法及临床诊断优选方案进行探讨。结果各种后处理技术均可以清晰显示血管轮廓及血管壁的钙化情况及支架的情况。对于动脉狭窄的显示,MPR、2mmMIP显示最佳。对于动脉栓子的检出,2mmMIP图像具有较大的优势。结论多种后处理方法综合运用,可以显示狭窄病变部位、范围、程度,闭塞远端血管充盈情况,管壁钙化及栓子的情况,术后腔内支架的情况,为临床诊断治疗提供重要信息。     

Beta‐2 transferrin is detectable for 14 days whether refrigerated or stored at room temperature

Background

The effect of time and temperature on beta‐2 transferrin stability in cerebrospinal fluid (CSF) is not well established. After collecting nasal CSF for testing, beta‐2 transferrin has been found to be stable and detectable for 1 week, whether being refrigerated or stored at room temperature. The purpose of this study was to determine if beta‐2 transferrin remained detectable longer than 1 week and whether refrigeration improved its detectability.

Methods

In patients undergoing therapeutic CSF diversion, 2‐mL CSF samples were collected from 18 patients. The samples were divided and stored either at room temperature, or at 4°C, and tested for beta‐2 transferrin at 7 and 14 days. CSF was collected from external ventricular drains (EVDs) (n = 15), lumbar drains (n = 2), and subdural drains (n = 1).

Results

Of the 18 CSF samples originally testing positive for beta‐2 transferrin, none turned negative at 7 or 14 days, in both the refrigerated and room temperature groups (95% confidence interval [CI], 0% to 18.5%).

Conclusion

Beta‐2 transferrin remained detectable for 14 days in all CSF samples, regardless of being stored at 4°C or room temperature.