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. 2022 Jun 2:35:10292.
doi: 10.3389/ti.2022.10292. eCollection 2022.

Post-Transplantation Cytomegalovirus Infection Interplays With the Development of Anastomotic Biliary Strictures After Liver Transplantation

Pauline Georges  1 , Clémentine Clerc  2 , Célia Turco  1 , Vincent Di Martino  3 , Brice Paquette  1 , Anne Minello  2 , Paul Calame  4 , Joséphine Magnin  1 , Lucine Vuitton  5 , Delphine Weil-Verhoeven  3 , Zaher Lakkis  1 , Claire Vanlemmens  3 , Marianne Latournerie  2 , Bruno Heyd  1 , Alexandre Doussot  1
Affiliations

Post-Transplantation Cytomegalovirus Infection Interplays With the Development of Anastomotic Biliary Strictures After Liver Transplantation

Pauline Georges et al. Transpl Int. .

Abstract

Background: Anastomotic biliary stricture (ABS) remains the most frequent complication after liver transplantation (LT). This study aimed to identify new anastomotic biliary stricture risk factors, with a specific focus on postoperative events. Additionally, ABS management and impact on patient and graft survival were assessed. Methods: All consecutive patients who underwent LT with duct-to-duct anastomosis between 2010 and 2019 were included. All patients who died within 90 days after LT due to non-ABS-related causes were excluded. Results: Among 240 patients, 65 (27.1%) developed ABS after a median time of 142 days (range, 13-1265). Median follow-up was 49 months (7-126). Upon multivariable analysis, donor BMI (OR=0.509, p = 0.037), post-LT CMV primoinfection (OR = 5.244, p < 0.001) or reactivation (OR = 2.421, p = 0.015) and the occurrence of post-LT anastomotic biliary fistula (OR = 2.691, p = 0.021) were associated with ABS. Anastomotic technical difficulty did not independently impact the risk of ABS (OR = 1.923, p = 0.051). First-line ABS treatment was systematically endoscopic (100%), and required a median of 2 (range, 1-11) procedures per patient. Repeat LT was not required in patients developing ABS. The occurrence of ABS was not associated with overall patient survival (p = 0.912) nor graft survival (p = 0.521). Conclusion: The risk of developing ABS after LT seems driven by the occurrence of postoperative events such as CMV infection and anastomotic fistula. In this regard, the role of CMV prophylaxis warrants further investigations.

Keywords: CMV infection; anastomotic biliary complications; biliary reconstruction; liver transplantation; primoinfection.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study flowchart.
FIGURE 2
FIGURE 2
Association between the occurrence of postoperative infection and anastomotic biliary stricture.
FIGURE 3
FIGURE 3
Overall survival and graft survival according to the development of anastomotic biliary stricture.
See this image and copyright information in PMC

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