Analysis of Biliary Stricture after ABO Incompatible Adult Living Donor Liver Transplantation

Young-In Yoon; Gi-Won Song; Sung-Gyu Lee; Shin Hwang; Chul-Soo Ahn; Ki-Hun Kim; Deok-Bog Moon; Tae-Yong Ha; Dong-Hwan Jung; Gil-Chun Park; Jung-Man Namgung; Yo-Han Park; Chun-Soo Park; Hyoung-Woo Park; Sung-Hwa Kang; Bo-Hyun Jung

doi:10.4285/jkstn.2012.26.4.277

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Yoon, Song, Lee, Hwang, Ahn, Kim, Moon, Ha, Jung, Park, Namgung, Park, Park, Park, Kang, and Jung: Analysis of Biliary Stricture after ABO Incompatible Adult Living Donor Liver Transplantation

Original Article

The Journal of the Korean Society for Transplantation

The Journal of the Korean Society for Transplantation 2012; 26(4): 277-286.

Published online: 31 December 2012

DOI: https://doi.org/10.4285/jkstn.2012.26.4.277

Analysis of Biliary Stricture after ABO Incompatible Adult Living Donor Liver Transplantation

Young-In Yoon, M.D., Gi-Won Song, M.D., Sung-Gyu Lee, M.D., Shin Hwang, M.D., Chul-Soo Ahn, M.D., Ki-Hun Kim, M.D., Deok-Bog Moon, M.D., Tae-Yong Ha, M.D., Dong-Hwan Jung, M.D., Gil-Chun Park, M.D., Jung-Man Namgung, M.D., Yo-Han Park, M.D., Chun-Soo Park, M.D., Hyoung-Woo Park, M.D., Sung-Hwa Kang, M.D., Bo-Hyun Jung, M.D.

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Corresponding author (drsong71@hotmail.com)

Received 6 October 2012 Accepted 12 December 2012

Abstract

Background

Despite recent improvements in survival outcome after ABO incompatible (ABOi) adult living donor liver transplantation (ALDLT), concerns about the incidence of biliary stricture (BS) still exist. However, reports on the actual incidence of BS have been scarce.

Methods

From November 2008 to August 2011, 77 cases of ABOi ALDLTs have been performed. We compared patient and graft survival and BS-free survival rates (BSFSR) between these ABOi ALDLTs and 734 ABO compatible (ABOc) ALDLTs performed during the same period. We also analyzed characteristics of BS in ABOi ALDLT.

Results

There was one mortality (1.3%) and one re-transplantation (due to small-for-size graft syndrome) among 77 cases of ABOi ALDLTs. Overall, 1-, 2-, and 3-year patient survival rates were 94.8%, comparable to ABOc ALDLTs (93.7%, 90.1%, 90.1%, P=0.20). BS occurred in 11 (13.8%) ABOi ALDLT patients. There were no significant differences in 1-, 2-, and 3-year BSFSR between ABOi and ABOc ALDLT patients (87.5% vs. 88.1%, 83.4% vs. 87.5%, and 83.4% vs. 86.4%, P=0.55). Among 10 patients with BS, four patients showed diffuse multiple intrahepatic strictures, which were linked to the death of two patients.

Conclusions

The survival outcome of ABOi ALDLT is comparable to ABOc ALDLT. The incidence of BS of ABOi ALDLT was not superior to that of ABOc ALDLT. However, ABO incompatibility is related to the development of diffuse multiple intrahepatic BSs (rarely seen in ABOc ALDLT) and can cause graft failure and patient death.

Keywords: Blood group incompatibility, Bile duct stricture, Living donor liver transplantation

Figures and Tables

Fig. 1

Comparison of 1-, 2-, and 3-year patient (A) and graft (B) survival rates between ABO incompatible (ABOi) and ABO compatible (ABOc) adult living donor liver transplantations.

Fig. 2

Comparison of 1-, 2-, and 3-year biliary stricture-free survival rate between ABO incompatible (ABOi) and ABO compatible (ABOc) adult living donor liver transplantation. Abbreviation: BS, biliary stricture.

Fig. 3

Diffuse multiple intrahepatic biliary strictures in (A) case 7, (B) case 25, (C) case 29, and (D) case 34.

Table 1

Demographic and clinical data of 77 ABOi adult living donor liver transplantations

Data are presented as mean±SD (range) or number (%).

Abbreviations: HBV, hepatitis B virus; LC, liver cirrhosis; CTP, Child-Turcotte-Pugh; HCV, hepatitis C virus; PCLD, polycystic liver disease; HCC, hepatocelluar carcinoma; MELD, model for end-stage liver disease; MRL, modified right lobe; LL, left lobe; ERL, extended right lobe; GRWR, graft-to-recipient weight ratio.

^aDeceased donor.

Table 2

Indication for liver transplantation in 77 ABOi adult living donor liver transplantations

Abbreviations: HCC, hepatocelluar carcinoma; HEP, hepatic encephalopathy; SBP, spontaneous bacterial peritonitis.

Table 3

The ABO blood group combinations in 77 ABOi adult living donor liver transplantations

Table 4

Comparison of demographic and clinical data between ABOi and ABOc living donor liver transplantations

Data are presented as mean±SD (range) or number (%).

Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; HCC, hepatocelluar carcinoma; MELD, model for end-stage liver disease; CTP, Child-Turcotte-Pugh; LT, liver transplantation; ICU, intensive care unit; RL, right lobe; LL, left lobe; GV/SLV, graft volume/standard liver volume; GRWR, graft-to-recipient weight ratio; BMI, body mass index; RBC, red blood cell.

^aDuring operation.

Table 5

Clinical characteristics of diffuse multiple intrahepatic biliary strictures

Abbreviations: M, male; MELD, model for end-stage liver disease; CTP, Child-Turcotte-Pugh; GRWR, graft-to-recipient weight ratio; BD, bile duct; CIT, cold ischemic time; WIT, warm ischemic time; TIT, total ischemic time; HBV, hepatitis B virus; MRL, modified right lobe; DD, duct-to-duct anastomosis; HCC, hepatocelluar carcinoma.

Table 6

Clinical characteristics of diffuse multiple intrahepatic biliary strictures

Abbreviations: IgM, immunoglobulin M; IgG, immunoglobulin G; LT, liver transplantation; PE, plasma exchange; AHR, acute humoral rejection; Tx, treatment; BS, biliary stricture; ERBD, endoscopic retrograde biliary drainage; PTBD, percutaneous transhepatic biliary drainage.

^aAfter operation.

Table 7

Univariate analysis for risk factors associated with duration of biliary stricture-free survival in 77 ABOi adult living donor liver transplantations

Abbreviations: DD, duct-to-duct anastomosis; HJ, hepaticojejunostomy; IgM, immunoglobulin M; IgG, immunoglobulin G.

Table 8

Multivariate analysis for the risk factors associated with duration of biliary stricture-free survival in 77 ABOi adult living donor liver transplantations

Abbreviation: IgG, immunoglobulin G.

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