Biliary complications in liver transplant patient

Abstract

Bilijarne komplikacije u bolesnika s transplantiranom jetrom danas predstavljaju značajan problem. Napretkom medicine, napredovala je i tehnika transplantacije jetre. Pacijenti koji su imali završni stadij zatajenja jetre i kojima je predviđeno da neće preživjeti duže od godinu dana transplantacijom jetre je omogućeno dulje preživljenje i bolja kvaliteta života. Kako svaka tehnika ima svoje prednosti, ali i nedostatke tako i pacijenti s transplantiranom jetrom imaju brojne komplikacije. Jedne od češćih komplikacija su bilijarne komplikacije čija je učestalost oko 30%. Postoperativne bilijarne komplikacije uključuju strikture (anastomotske i neanastomotske), bilijarna curenja, bilijarne kamence, disfunkciju Odijevog sfinktera, bilome i hemobiliju. Incidencija im varira ovisno o broju rizičnih čimbenika koji doprinose razvoju komplikacija a neki od njih su: varijacije u anatomiji žučnih vodova, razlika u veličini žučnih vodova u primatelja i donora, ishemija žučnih vodova (može je uzrokovati tromboza jetrene arterije, toplo i hladno ishemijsko vrijeme, stenoza jetrene arterije), metode bilijarne rekontrukcije ( tip, način šivanja, materijal šava, primjena stenta ili T-cijevi), imunološki odgovor organizma ( AB0 inkompatibilnost) i infekcija. Dijagnoza bilijarnih komplikacija se temelji na kliničkoj slici i na temelju brojnih slikovnih metoda koji uključuju ERCP, MRCP, PTC, UZV. Zlatnim standardom se smatra ERCP jer u jednom zahvatu možemo prikazati problem i pokušati ga riješiti. Ako endoskopskim metodama ne riješimo problem pristupamo rješavanju problema kirurški. U nekim slučajevima svim navedenim metoda ne uspijevamo riješiti problem te tada pristupamo retransplantaciji.Biliary complications in patients with liver transplant represent a significant problem today. As medicine advanced, the technique of liver transplantation advanced with it. The liver transplant enabled the patients who had the end-stage liver disease and who were diagnosed not to live for more than a year a longer life and a better quality of life. As every technique has its advantages and disadvantages, the patients with liver transplant encounter a number of complications, as well. One of the most frequent complications are biliary complications, whose incidence is about 30%. Postoperative complications include biliary strictures (anastomotic and nonanastomotic), biliary leaks, biliary stones, sphincter of Oddi dysfunction, biloma and haemobilia. Their incidence varies depending on the number of risk factors that contribute to the development of complications and some of them are: variations in the anatomy of the bile ducts, the difference in size of the bile ducts of the recipient and the donor, bile ducts ischemia (it can cause thrombosis of the hepatic artery, warm and cold ischemia time, hepatic artery stenosis), methods of biliary reconstructions (type, method of sewing, suture material, the use of stents or T-tube), immune response (AB0 incompatibility) and infections. The diagnosis of biliary complications is based on the clinical picture and on the basis of a number of imaging methods that include ERCP, MRCP, PTC. ERCP is considered to be the golden standard because we can discover the problem and try to solve it with only one procedure. If endoscopic methods do not resolve the problem, we approach the problem surgically. In some cases, all of these methods fail to resolve the problem and then the only remaining solution is retransplantation