Faculty Collaboration Database

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes. Liver Transpl 2008 Oct;14(10):1466-72

Date

10/01/2008

Pubmed ID

18825683

DOI

10.1002/lt.21492

Scopus ID

2-s2.0-57849159816 (requires institutional sign-in at Scopus site)   64 Citations

Abstract

Biliary cast syndrome (BCS), the presence of biliary casts and debris causing biliary obstruction, occurs in 4%-18% of orthotopic liver transplant (OLT) recipients. Potential consequences include cholangitis and graft damage or loss. Limited data exist regarding the etiology and outcomes of BCS. The purpose of this study was to evaluate donor and recipient risk factors and determine the impact of BCS. A retrospective review of 355 OLT cases identified 9 BCS patients (2.5%) diagnosed by cholangiography. Twenty-six matched controls were also identified. The warm ischemic time was significantly longer in BCS patients. Other recipient and donor preoperative and intraoperative characteristics, including the donor risk index, revealed no significant differences. Overall patient survival showed a trend toward worse outcomes at 6, 12, and 18 months and end of follow-up in the BCS group. Overall graft survival was also worse in the BCS group at all time periods, with statistical significance demonstrated at 18 months and end of follow-up. The number of therapeutic biliary procedures and hospital readmissions was significantly higher in the BCS group. Twenty-two percent of the BCS patients required repeat OLT versus none of the control patients. In conclusion, BCS is an uncommon complication of OLT. Except for a longer warm ischemic time, recipient and donor factors did not predict the occurrence of BCS. BCS patients showed a significantly worse graft survival, as well as a trend toward worse patient survival. Given the negative impact of BCS on liver transplant outcomes, further studies appear justified.

Author List

Gor NV, Levy RM, Ahn J, Kogan D, Dodson SF, Cohen SM

Author

Dmitriy Kogan MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Biliary Tract Diseases
Female
Graft Survival
Humans
Liver Transplantation
Male
Middle Aged
Postoperative Complications
Radiography
Retrospective Studies
Risk Factors
Statistics, Nonparametric
Tissue Donors
United States