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Structures after liver transplantation
Last reviewed: 23.04.2024
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Complications from the biliary tract after liver transplantation develop in 10-20% of cases. These include strictures, the flow of bile, fistula and cholangitis. Strictures of anastomoses due to technical errors, inflammation due to bile flow and fibrosis, and strictures that are not associated with anastomoses, which are formed above the anastomosis in the direction of the gates of the liver, caused in some cases by ischemia of the ducts can be observed .
The distal part of the bile duct (recipient) receives copious blood supply from the collaterals. Blood supply of the proximal part (donor) is worse and is provided by peribiliary plexuses formed from the reconstructed hepatic artery. After thrombosis of the hepatic artery, there is an outflow of bile with necrosis of the duct wall, not associated with an anastomosis. The development of strictures not related to anastomosis appears to be independent of the method of reconstruction of the bile ducts (choledochocholedochostomy or anastomosis with the bowel loop turned off). In most cases, strictures in the region of the gates of the liver are formed within 3 months after transplantation.
The development of strictures that are not related to anastomosis can be facilitated, in addition to ischemia, by the slowing down of healing processes due to the use of high doses of corticosteroids, infection, a chronic reaction of rejection with duktopenia and arteriopathy.
Biliary outflow can be associated with T-shaped drainage tubes and occurs when they are displaced or removed. Drainage with a T-tube was used to prevent biliary complications, but did not affect their frequency, which did not increase with no drainage.
[Symptoms of strictures after liver transplantation
Indicators of liver function are deteriorating; there may be signs of sepsis. It is necessary to exclude other causes of impaired liver function by biopsy and serological testing for virus markers. In the range of differential diagnosis include rejection reaction, sepsis of any etiology, cytomegalovirus infection, relapse of the underlying disease, drug damage.
Diagnosis of strictures after liver transplantation
Signs of the defeat of the bile ducts can be an intermittent increase and decrease in the serum bilirubin level and significant transaminase activity fluctuations that do not depend on immunosuppressive therapy.
Ultrasound reveals an extension of the ducts or bile ducts. Doppler ultrasound is performed to assess blood flow through the hepatic artery. If there are no pathological changes with ultrasound, a liver biopsy or cholangiography is performed. In ERCPH, the outflow of bile or stricture is detected.
Treatment of strictures after liver transplantation
With the development of posttransplant strictures (both connected and not connected with anastomosis), revision or reconstruction of the anastomosis is often required; balloon dilatation and stent placement are also used. Factors contributing to the successful elimination of strictures by the methods of X-ray and endoscopic surgery, need further study.