Biliary complications are common after living donor liver transplant(LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leak...Biliary complications are common after living donor liver transplant(LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leaks. Endoscopic retrograde cholangiopancreatography(ERCP) is the first line modality of treatment of post LDLT biliary strictures with a technical success rate of 75%-80%. Most of ERCP failures are successfully treated by percutaneous transhepatic biliary drainage(PTBD) and rendezvous technique. A minority of patients may require surgical correction. ERCP for these strictures is technically more challenging than routine as well post deceased donor strictures. Biliary strictures may increase the morbidity of a liver transplant recipient, but the mortality is similar to those with or without strictures. Post transplant strictures are short segment and soft, requiring only a few session of ERCP before complete dilatation. Long-term outcome of patients with biliary stricture is similar to those without stricture. With the introduction of new generation cholangioscopes, ERCP success rate may increase, obviating the need for PTBD and surgery in these patients.展开更多
Background and Aims:The anticipated fear of serious out-comes in coronavirus infected liver transplant recipients led to disruption of transplant services globally.The aim of our study was to analyze COVID-19 severity...Background and Aims:The anticipated fear of serious out-comes in coronavirus infected liver transplant recipients led to disruption of transplant services globally.The aim of our study was to analyze COVID-19 severity in transplant recipients and to compare the difference of COVID-19 clinical outcomes in early(<1 year)vs.late(>1 year)post-transplant period.Methods:41 post-living donor liver transplant recipients with COVID-19 infection were studied retrospectively from 1st April 2020 to 28th February 2021.Results:The median age was 49.00 years with a male preponderance(80.49%).Fif-teen patients had infection within 1 year of transplant and 26 were infected after 1 year of transplant.The overall median interval between transplantation and COVID-19 diagnosis was 816.00 days.Fever and malaise were the common presenting symptoms.The most common associated comorbidities were diabetes mellitus(65.85%)and hypertension(46.34%).The severity of illness was mild in 28(68.29%),moderate in 4(9.76%),severe in 6(14.63%)and critical in 3(7.32%).To identify associated risk factors,we divided our patients into less severe and more severe groups.Except for lymphopenia,there was no worsening of total bilirubin,transaminases,al-kaline phosphatase,and gamma-glutamyl transferase in the more severe group.Eight(19.51%)patients required inten-sive care unit admission and three(7.32%)died,while none suffered graft rejection.In recipients with early vs.late post-transplant COVID-19 infection,there were similar outcomes in terms of severity of COVID-19 illness,intensive care unit care need,requirement of respiratory support,and death.Conclusion:Living donor liver transplantation can be per-formed during the COVID-19 pandemic without the fear of poor recipient outcome in cases of unfortunate contraction of severe acute respiratory syndrome coronavirus-2.展开更多
文摘Biliary complications are common after living donor liver transplant(LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leaks. Endoscopic retrograde cholangiopancreatography(ERCP) is the first line modality of treatment of post LDLT biliary strictures with a technical success rate of 75%-80%. Most of ERCP failures are successfully treated by percutaneous transhepatic biliary drainage(PTBD) and rendezvous technique. A minority of patients may require surgical correction. ERCP for these strictures is technically more challenging than routine as well post deceased donor strictures. Biliary strictures may increase the morbidity of a liver transplant recipient, but the mortality is similar to those with or without strictures. Post transplant strictures are short segment and soft, requiring only a few session of ERCP before complete dilatation. Long-term outcome of patients with biliary stricture is similar to those without stricture. With the introduction of new generation cholangioscopes, ERCP success rate may increase, obviating the need for PTBD and surgery in these patients.
文摘Background and Aims:The anticipated fear of serious out-comes in coronavirus infected liver transplant recipients led to disruption of transplant services globally.The aim of our study was to analyze COVID-19 severity in transplant recipients and to compare the difference of COVID-19 clinical outcomes in early(<1 year)vs.late(>1 year)post-transplant period.Methods:41 post-living donor liver transplant recipients with COVID-19 infection were studied retrospectively from 1st April 2020 to 28th February 2021.Results:The median age was 49.00 years with a male preponderance(80.49%).Fif-teen patients had infection within 1 year of transplant and 26 were infected after 1 year of transplant.The overall median interval between transplantation and COVID-19 diagnosis was 816.00 days.Fever and malaise were the common presenting symptoms.The most common associated comorbidities were diabetes mellitus(65.85%)and hypertension(46.34%).The severity of illness was mild in 28(68.29%),moderate in 4(9.76%),severe in 6(14.63%)and critical in 3(7.32%).To identify associated risk factors,we divided our patients into less severe and more severe groups.Except for lymphopenia,there was no worsening of total bilirubin,transaminases,al-kaline phosphatase,and gamma-glutamyl transferase in the more severe group.Eight(19.51%)patients required inten-sive care unit admission and three(7.32%)died,while none suffered graft rejection.In recipients with early vs.late post-transplant COVID-19 infection,there were similar outcomes in terms of severity of COVID-19 illness,intensive care unit care need,requirement of respiratory support,and death.Conclusion:Living donor liver transplantation can be per-formed during the COVID-19 pandemic without the fear of poor recipient outcome in cases of unfortunate contraction of severe acute respiratory syndrome coronavirus-2.
