CANLI DONÖR KARACİĞER NAKİL SONRASI BİLİYER KAÇAKLARIN PERKÜTAN TEDAVİSİ

Year 2019, Volume: 82 Issue: 4, 180 - 185, 21.10.2019

Sadık Server , Koray Güven

Abstract

Amaç: Biliyer kaçak (BK), canlı donör karaciğer nakli (CDKN) sonrası sık görülen komplikasyonlar arasındadır. Radyolojik yöntemler, tanıda ve tedavide önemlidir. Endoskopik yaklaşımlar BK’larda ilk basamak tedavi seçeneği kabul edilmekle birlikte günümüzde artan deneyim girişimsel radyolojik yaklaşımların rolunü de giderek arttırmaktadır. Çalışmamızda, CDKN sonrası gelişen BK’ların tanı ve tedavisinde deneyimimizi analiz etmeyi amaçlıyoruz. Gereç ve Yöntemler: Ocak 2015 – Aralık 2018 arasında merkezimizde gerçekleştirilen ardışık 361 CDKT olgu retrospektif olarak analiz edildi. BK şüphesi bulunan hastalarda kaçak tanısı ve yeri, safra yollarından ekskrete edilen gadoksetate disodyum kontrast madde kullanarak alınan manyetik rezonans kolanjiyopankreatografi (MRKP) ile gösterildi. Safra kaçakları, endoskopik, girişimsel radyolojik yaklaşımlar, cerrahi ve konservatif olarak tedavi edildi. Bulgular: Total 361 olgunun 27’sinde (%7,4) BK mevcut idi. BK’ların 26’sı (%96,2) anastomotik, 1’i ise (%3,7) kesi yüzey kaçağı idi. Bir hasta (%3,7) endoskopik, 23 hasta (% 85,1) girişimsel radyolojik, iki hasta (%7,4) cerrahi ve bir hasta (%3,7) konservatif yaklaşım ile tedavi edildi. Girişimsel radyolojik işlemler sırasında herhangi minor ve major komplikasyon gelişmedi. İşlem sonrasında ise 6 hastada (%26) minor komplikasyon [4 (%17,4) hafif kolanjitik atak, 2 (%8,6) hafif ödematöz pankreatit] gelişti. Sonuç: CDKT sonrası safra yollarının çoklu anastomozlu olması endoskopik tedavi yaklaşımlarını zorlaştırmaktadır. Girişimsel radyolojik yaklaşımlar deneyim gerektirmekle birlikte alternatif yöntem olarak uygulanabilir.

Keywords

Biliyer kaçak, canlı karaciğer nakli, perkütan tedavi

PERCUTANEOUS TREATMENT OF BILE LEAKAGE AFTER LIVING DONOR LIVER TRANSPLANTATION

Abstract

Objective: Biliary leakage (BL) is one of the most frequent complications following living donor liver transplantation (LDLT). Radiological methods are important in diagnosis and treatment. Although endoscopic approaches are considered as the firstline treatment option in BL, nowadays, increasing experience is strengthening the role of interventional radiological approaches. In our article, we aim to analyze our experience in the diagnosis and treatment of BLs developed after LDLT. Material and methods: Between January 2015 and December 2018, 361 LDLT cases performed consecutive at our center were analyzed retrospectively. The leakage diagnosis and location was demonstrated by magnetic resonance cholangiopancreatography (MRCP) with hepatobiliary excreted contrast agent gadoxetate disodium in patients with suspected leakage. BLs were treated by endoscopic, interventional radiological, surgical or conservative approaches. Results: Of the total 361 cases, 27 (7.4%) had BL. Twenty six (96%) of the BL were anastomotic and 1 (3,7%) was incision surface leakage. One patient (3.7%) was treated by endoscopic sphincterotomy methods, 23 (85,1%) patients by interventional radiological approaches, two patients (7.4%) by surgery and 1 patient (3,7%) by conservative approaches. There were no minor and major complications during interventional radiological procedures. After the procedure, minor complications (mild cholangitic attack) in 4 (17.4%), mild edematous pancreatitis in 2 (8,6%) developed in 6 (26%) patients. Conclusion: Endoscopic treatment approaches may be complicated in patients with multiple anastomosis of biliary tract after LDLT. Although interventional radiological approaches require experience, they can be performed as an alternative treatment method.

Keywords

Biliary leakage, living donor liver transplantation, percutaneous treatment

References

• 1. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference European Association for the Study of the Liver. J Hepatol 2001;35(3):421-30.
• 2. Cheng Fang, Sheng Yan, and Shusen Zheng. Bile Leakage after Liver Transplantation. Open Med 2017;12:424-9.
• 3. Chok KS, Chan SC, Cheung TT, Sharr WW, Chan AC, Lo CM, et al. Bile duct anastomotic stricture after adult-to-adult right lobe living donor liver transplantation. Liver Transpl 2011;17:47-52.
• 4. Chok KS, Chan SC, Cheung TT, Sharr WW, Chan AC, Fan ST, et al. A retrospective study on risk factors associated with failed endoscopic treatment of biliary anastomotic stricture after right-lobe living donor liver transplantation with ductto-duct anastomosis. Ann Surg 2014;259:767-72.
• 5. Pascher A, Neuhaus P. Bile duct complications after liver transplantation. Transpl Int 2005;18:627-42.
• 6. Ayoub WS, Esquivel CO, Martin P. Biliary complications following liver transplantation. Dig Dis Sci 2010;55:1540-6.
• 7. Park SH, Kim KW, Kim B, Lee SJ, Lee JS, Kim HJ, et al. Imaging of biliary complications in recipients of rightlobe living donor liver transplantation. Acta Radiol 2016;57(4):401-12.
• 8. Katz LH, Benjaminov O, Belinki A, Geler A, Braun M, Knizhnik M, et al. Magnetic resonance cholangiopancreatography for the accurate diagnosis of biliary complications after liver transplantation: comparison with endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography - long-term follow-up. Clin Transplant 2010;24:163-9.
• 9. Dechene A, Kodde C, Kathemann S, Treckmann J, Lainka E, Paul A, et al. Endoscopic treatment of pediatric posttransplant biliary complications is safe and effective. Dig Endosc. 2015;27(4):505-11.
• 10. Chok KS, Chan AC, Sharr WW, Cheung TT, Fung JY, Chan SC, et al. Outcomes of endo-radiological approach to management of bile leakage after right lobe living donor liver transplantation. J Gastroenterol Hepatol 2016;31(1):190-3.
• 11. Ko GY, Sung KB. Section 11. Radiological intervention approaches to biliary complications after living donor liver transplantation. Transplantation 2014;97:43-6.
• 12. Weber A1, Gaa J, Rosca B, Born P, Neu B, Schmid RM, et al. Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts. Eur J Radiol 2009;72(3):412-7.
• 13. Lo CM, Fan ST, Liu CL, Yong BH, Wong Y, Lau GK, et al. Lessons learned from 100 right lobe living donor liver transplants. Ann Surg Ann Surg 2004;240(1):151-8.
• 14. Memeo R, Piardi T, Sangiuolo F, Sommacale D, Pessaux P. Management of biliary complications after liver transplantation. World J Hepatol 2015:18;7(29):2890-5.
• 15. Kochhar G, Parungao JM, Hanouneh IA, Parsi MA. Biliary complications following liver transplantation. World J Gastroenterol 2013;19(19):2841-6.
• 16. Gondolesi GE, Varotti G, Florman SS, Muñoz L, Fishbein TM, Emre SH, et al. Biliary complications in 96 consecutive right lobe living donor transplant recipients. Transplantation. 2004;77:1842-8.
• 17. Zimmerman MA, Baker T, Goodrich NP, Freise C, Hong JC, Kumer S, et al. Development, management, and resolution of biliary complications after living and deceased donor liver transplantation: a report from the adult-to-adult living donor liver transplantation cohort study consortium. Liver Transpl 2013;19:259-67.
• 18. Fan ST, Lo CM, Liu CL, Tso WK, Wong J. Biliary reconstruction and complications of right lobe live donor liver transplantation. Ann Surg 2002;236(5):676-83.
• 19. Hoekstra LT, van Gulik TM, Gouma DJ, Busch OR. Posthepatectomy bile leakage: how to manage. Dig Surg 2012; 29: 48-53.
• 20. Daniel K, Said A. Early Biliary complications after liver transplantation. Clin Liver Dis (Hoboken) 2017;10(3):63-7.