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Area of Science:

  • Hepatobiliary surgery
  • Transplantation medicine
  • Gastroenterology

Background:

  • Biliary duct stones (BDS) are a potential complication following liver transplantation (LT).
  • Understanding the incidence, risk factors, and outcomes associated with BDS is crucial for improving patient care.

Purpose of the Study:

  • To review the incidence of BDS after LT.
  • To identify risk factors and predictive factors for BDS onset.
  • To evaluate treatment outcomes and impact on graft survival.

Main Methods:

  • Retrospective analysis of liver transplants performed between 2004 and 2014.
  • Identification of risk factors using univariable Cox's proportional hazards models.
  • Analysis of graft survival rates in relation to BDS occurrence.

Main Results:

  • BDS were identified in 3.5% of analyzed liver grafts.
  • Biliary strictures were the primary predictive factor for BDS (HR 9.94).
  • Other risk factors included high bilirubin, MELD score, prolonged surgery, hepatocellular disease, hepatic artery thrombosis, and retransplantation.
  • Female sex was a significant risk factor for BDS in grafts with biliary strictures (HR 5.19).
  • Multimodality treatment was often successful, but 23% required open surgery.
  • BDS did not significantly influence 1-, 5-, or 10-year graft survival.

Conclusions:

  • Biliary strictures are the main predictor of BDS in liver grafts.
  • Female sex is a key risk factor for BDS in the presence of biliary strictures.
  • Hepatic artery thrombosis increases BDS risk in the absence of biliary strictures.
  • While treatment is often successful, BDS do not adversely affect long-term graft survival.