Liver transplant biliary strictures linked to increased rates of allograft rejection
Post-liver transplant biliary strictures correlated with increased rates of allograft rejection, allograft failure, infections and readmissions, according to a study published in the Journal of Gastroenterology and Hepatology.
“Compared to [endoscopic retrograde cholangiopancreatography (ERCP)], management of these patients with [interventional radiology (IR)] or surgical interventions is associated with a significantly higher rates of allograft failure and hospital stay,” Divyanshoo R. Kohli, MD, from Kansas City VA Medical center, and colleagues wrote
Kohli and colleagues used a nationwide readmissions database to identify 8,300 liver transplant recipients, of whom 554 had biliary strictures. Investigators compared patients with post‐transplant biliary strictures with transplant recipients without strictures. They also compared outcomes between interventional radiology, surgical interventions and ERCP among patients with biliary strictures who underwent therapeutic intervention.
Adjusted odds ratio for various outcomes in patients with biliary strictures, compared with those without strictures, were 1.46 (95% CI, 1.2-1.77) for 30‐day non‐elective readmission, 2.71 (95% CI, 2.04-3.59) for allograft rejection, 2.32 (95% CI, 1.61-3.37) for liver transplant failure, 3.05 (95% CI, 1.39-6.73) for infection, and 1.41 (95% CI, 1.08-1.82) disposition to skilled nursing or intermediate care facility. During index hospitalization, 350 patients received therapeutic interventions: ERCP in 163 patients, surgery in 144 patients and IR in 43 patients.
“Compared to ERCP, the adjusted odds for various outcomes were: disposition to skilled nursing or intermediate care facility 2.72 [95% CI, 1.08-6.87] and 2.09 [95% CI, 1.05-4.15]; prolongation of hospitalization 14.4 [95% CI, 3.7-25.1] and 15 [95% CI, 7.4-22.7]; failure of liver allograft 8.47 [95% CI, 1.47-48.6] and 12.23 95% CI, 2.74-54.4] for IR and surgical interventions respectively,” Kohli and colleagues wrote.