Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Sep 5;9(9):e105795.
doi: 10.1371/journal.pone.0105795. eCollection 2014.

New diagnosis and therapy model for ischemic-type biliary lesions following liver transplantation--a retrospective cohort study

Ying-cai Zhang  1 , En-ze Qu  2 , Jie Ren  2 , Qi Zhang  3 , Rong-qin Zheng  2 , Yang Yang  1 , Gui-hua Chen  1
Affiliations

New diagnosis and therapy model for ischemic-type biliary lesions following liver transplantation--a retrospective cohort study

Ying-cai Zhang et al. PLoS One. .

Retraction in

Abstract

Ischemic-type biliary lesions (ITBLs) are a major cause of graft loss and mortality after orthotopic liver transplantation (OLT). Impaired blood supply to the bile ducts may cause focal or extensive damage, resulting in intra- or extrahepatic bile duct strictures or dilatations that can be detected by ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and cholangiography. However, the radiographic changes occur at an advanced stage, after the optimal period for therapeutic intervention. Endoscopic retrograde cholangio-pancreatography (ERCP) and percutaneous transhepatic cholangiodrainage (PTCD) are the gold standard methods of detecting ITBLs, but these procedures cannot be used for continuous monitoring. Traditional methods of follow-up and diagnosis result in delayed diagnosis and treatment of ITBLs. Our center has used the early diagnosis and intervention model (EDIM) for the diagnosis and treatment of ITBLs since February 2008. This model mainly involves preventive medication to protect the epithelial cellular membrane of the bile ducts, regular testing of liver function, and weekly monitor of contrast-enhanced ultrasonography (CEUS) to detect ischemic changes to the bile ducts. If the liver enzyme levels become abnormal or CEUS shows low or no enhancement of the wall of the hilar bile duct during the arterial phase, early ERCP and PTCD are performed to confirm the diagnosis and to maintain biliary drainage. Compared with patients treated by the traditional model used prior to February 2008, patients in the EDIM group had a lower incidence of biliary tract infection (28.6% vs. 48.6%, P = 0.04), longer survival time of liver grafts (24±9.6 months vs. 17±12.3 months, P = 0.02), and better outcomes after treatment of ITBLs.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Algorithm for the diagnosis and treatment of ITBLs after OLT in the control group.
ERCP, endoscopic retrograde cholangio-pancreatography; ITBLs, ischemic-type biliary lesion; MRCP, magnetic resonance cholangiopancreatography; OLT, orthotopic liver transplantation; PTCD, percutaneous transhepatic cholangiodrainage.
Figure 2
Figure 2. Algorithm for the diagnosis and treatment of ITBLs after OLT in the EDIM group.
CEUS, contrast-enhanced ultrasonography; EDIM, early diagnosis and intervention mode; ERCP, endoscopic retrograde cholangio-pancreatography; ITBLs, ischemic-type biliary lesion; MRCP, magnetic resonance cholangiopancreatography; OLT, orthotopic liver transplantation; PTCD, percutaneous transhepatic cholangiodrainage.
Figure 3
Figure 3. Ultrasound image of the hilar bile duct in a patient without ITBLs.
B: Regular ultrasound image showing a thickened hilar bile duct wall with a high echogenicity (arrow) and an obscure lumen. A: Arterial stage of CEUS showing high enhancement of the bile duct (arrow) and a clear lumen. CEUS: contrast-enhanced ultrasound; OLT: orthotopic liver transplantation.
Figure 4
Figure 4. Ultrasound image of the hilar bile duct in a patient with ITBLs.
B: Regular ultrasound image showing a thickened hilar bile duct wall with equal echogenicity (arrow) and an obscure lumen. A: Arterial stage of CEUS showing low enhancement in the bile duct wall (arrow) and a clear lumen.
Figure 5
Figure 5. Survival times of liver grafts in the two groups.
The 1- and 3-year graft survival rates were 78.4% and 53.2% in the control group and 92.9% and 78.6% in the EDIM group (P = 0.008).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Buis CI, Hoekstra H, Verdonk RC, Porte RJ (2006) Causes and consequences of ischemic-type biliary lesions after liver transplantation. J Hepatobiliary Pancreat Surg 13: 517–524. - PubMed
    1. Sawyer RG, Punch JD (1998) Incidence and management of biliary complications after 291 liver transplants following the introduction of transcystic stenting. Transplantation 66: 1201–1207. - PubMed
    1. Turrion VS, Alvira LG, Jimenez M, Lucena JL, Nuno J, et al. (1999) Management of the biliary complications associated with liver transplantation: 13 years of experience. Transplant Proc 31: 2392–2393. - PubMed
    1. Rizk RS, McVicar JP, Emond MJ, Rohrmann CA Jr, Kowdley KV, et al. (1998) Endoscopic management of biliary strictures in liver transplant recipients: effect on patient and graft survival. Gastrointest Endosc 47: 128–135. - PubMed
    1. Ward EM, Kiely MJ, Maus TP, Wiesner RH, Krom RA (1990) Hilar biliary strictures after liver transplantation: cholangiography and percutaneous treatment. Radiology 177: 259–263. - PubMed

Publication types

MeSH terms