2013 г. №1 Том 21

ОБЗОРЫ

И.И. ПИКИРЕHЯ 1, Ш.З. ШАРИПОВ 1, О.С. БОГУШЕВИЧ 2

БИЛИАРHЫЕ СТРИКТУРЫ ПОСЛЕ ОРТОТОПИЧЕСКОЙ ТРАHСПЛАHТАЦИИ ПЕЧЕHИ

ГУО «Белорусская медицинская академия последипломного образования» 1,
Комитет по здравоохранению Мингорисполкома 2, г. Минск,
Республика Беларусь

В статье представлен обзор исследований, посвященных изучению факторов риска развития билиарных осложнений после трансплантации печени. Анализ литературы показал, что, несмотря на значительные достижения трансплантации печени в лечении пациентов с терминальной стадией ее поражения, обусловленной циррозом и рядом очаговых заболеваний, все еще остается высокая частота развития билиарных осложнений в посттрансплантационном периоде.
Наиболее распространенными видами билиарных осложнений, развивающихся после ортотопической трансплантации, являются: несостоятельность билиарного и билиодигистивного анастомозов, их стриктура, а также неанастомотические стриктуры желчных протоков. Среди множества факторов, влияющих на развитие билиарных осложнений в посттрансплантационном периоде, основными являются: длительная холодовая ишемия трансплантата, нарушение кровообращения желчных протоков, технические проблемы.
Обобщая данные литературы, факторы риска неанастомотических стриктур можно разделить на три основные группы: ишемические, иммунологические и индуцированные солями желчных кислот.
Наличие множества факторов риска развития билиарных осложнений требует дальнейшего изучения их и разработки методов предупреждения развития билиарных осложнений после ортотопической трансплантации печени.

Ключевые слова: ортотопическая трансплантация печени, билиарные осложнения, неанастомотические билиарные стриктуры
с. 105 – 110 оригинального издания
Список литературы
  1. Welch C. A note on transplantation of the whole liver in dogs. Transplant Bull. 1955;2:54–55.
  2. Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantation of the liver in humans. Surgery Gynecol Obstet. 1963 Dec;117:659–76.
  3. Calne RY. A new technique for biliary drainage in orthotopic liver transplantation utilizing the gall bladder as a pedicle graft conduit between the donor and recipient common bile ducts. Ann Surg. 1976 Nov;184(5):605–609.
  4. Liang TB. Biliary tract complications after liver transplantation. Hepatobiliary Pancreat Dis Int. 2005 Feb;4(1):10–1.
  5. Pascher A, Neuhaus P. Biliary complications after deceased-donor orthotopic liver transplantation. J Hepatobiliary Pancreat Surg. 2006;13(6):487–96.
  6. Noack K, Bronk SF, Kato A, Gores GJ. The greater vulnerability of bile duct cells to reoxygenation injury than to anoxia. Implications for the pathogenesis of biliary strictures after liver transplantation. Transplantation. 1993 Sep;56(3):495–500.
  7. Buis CI, Hoekstra H, Verdonk RC, Porte RJ.Causes and consequences of ischemic-type biliary lesions after liver transplantation. J Hepatobiliary Pancreat Surg. 2006;13(6):517–24.
  8. Colonna JO 2nd, Shaked A, Gomes AS, Colquhoun SD, Jurim O, McDiarmid SV, Millis JM, Goldstein LI, Busuttil RW. Biliary strictures complicating liver transplantation. Incidence, pathogenesis, management, and outcome. Ann Surg. 1992 Sep;216(3):344–50.
  9. Geuken E, Visser D, Kuipers F, Blokzijl H, Leuvenink HG, de Jong KP, Peeters PM, Jansen PL, Slooff MJ, Gouw AS, Porte RJ. Rapid increase of bile salt secretion is associated with bile duct injury after human liver transplantation. J Hepatol. 2004 Dec;41(6):1017–25.
  10. Hoekstra H, Porte RJ, Tian Y, Jochum W, Stieger B, Moritz W, Slooff MJ, Graf R, Clavien PA. Bile salt toxicity aggravates cold ischemic injury of bile ducts after liver transplantation in Mdr2+/- mice. Hepatology. 2006 May;43(5):1022–31.
  11. Neuhaus P, Blumhardt G, Bechstein WO, Steffen R, Platz KP, Keck H. Technique and results of biliary reconstruction using side-to-side choledochocholedochostomy in 300 orthotopic liver transplants. Ann Surg. 1994 Apr;219(4):426–34.
  12. Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation: past, present and preventive strategies. Liver Transpl. 2008 Jun;14(6):759–69.
  13. Fleck A, Zanotelli ML, Meine M, Brandao A, Leipnitz I, Schlindwein E, Cassal A, Grezzana T, Marroni C, Cantisani GP, Santos RR. Biliary tract complications after orthotopic liver transplantation in adult patients. Transplant Proc. 2002 Mar;34(2):519–20.
  14. Greif F, Bronsther OL, Van Thiel DH, Casavilla A, Iwatsuki S, Tzakis A, Todo S, Fung JJ, Starzl TE. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg. 1994 Jan;219(1):40–5.
  15. Thethy S, Thomson BNj, Pleass H, Wigmore SJ, Madhavan K, Akyol M, Forsythe JL, James Garden O. Management of biliary tract complications after orthotopic liver transplantation. Clin Transplant. 2004 Dec;18(6):647–53.
  16. Roumilhac D, Poyet G, Sergent G, Declerck N, Karoui M, Mathurin P, Ernst O, Paris JC, Gambiez L, Pruvot FR. Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation. Liver Transpl. 2003 Apr;9(4):394–400.
  17. Pomposelli J.J., Jenkins R.L. Early and late complication of liver transplantation. In: L.H. Blumgart, ed. Surgery of the liver, biliary tract and pancreas. 4th ed. Philadelpia, US: Saunders Elseiver, 2007;2. p. 1801–802.
  18. Hintze RE, Adler A, Veltzke W, Abou-Rebyeh H, Felix R, Neuhaus P.
  19. Endoscopic management of biliary complications after orthotopic liver transplantation. Hepatogastroenterology. 1997 Jan-Feb;44(13):258–62.
  20. St Peter S, Rodriquez-Davalos MI, Rodriguez-Luna HM, Harrison EM, Moss AA, Mulligan DC. Significance of proximal biliary dilatation in patients with anastomotic strictures after liver transplantation. Dig Dis Sci. 2004 Aug;49(7-8):1207–11.
  21. Mahajani RV, Cotler SJ, Uzer MF. Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation. Endoscopy. 2000 Dec;32(12):943–49.
  22. Morelli J, Mulcahy HE, Willner IR, Cunningham JT, Draganov P. Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement. Gastrointest Endosc. 2003 Sep;58(3):374–79.
  23. Rossi AF, Grosso C, Zanasi G, Gambitta P, Bini M, De Carlis L, Rondinara G, Arcidiacono R. Long-term efficacy of endoscopic stenting in patients with stricture of the biliary anastomosis after orthotopic liver transplantation. Endoscopy. 1998 May;30(4):360–66.
  24. Jagannath S, Kalloo AN. Biliary Complications After Liver Transplantation. Curr Treat Options Gastroenterol. 2002 Apr;5(2):101–12.
  25. Moser MA, Wall WJ. Management of biliary problems after liver transplantation. Liver Transpl. 2001 Nov;7(11 Suppl. 1):S46–52.
  26. Liao JZ, Zhao Q, Qin H, Li RX, Hou W, Li PY, Liu NZ, Li DM. Endoscopic diagnosis and treatment of biliary leak in patients following liver transplantation: a prospective clinical study. Hepatobiliary Pancreat Dis Int. 2007 Feb;6(1):29–33.
  27. Guichelaar MM, Benson JT, Malinchoc M, Krom RA, Wiesner RH, Charlton MR. Risk factors for and clinical course of non-anastomotic biliary strictures after liver transplantation. Am J Transplant. 2003 Jul;3(7):885–90.
  28. Sanchez-Urdazpal L, Gores GJ, Ward EM, Maus TP, Buckel EG, Steers JL, Wiesner RH, Krom RA. Diagnostic features and clinical outcome of ischemic-type biliary complications after liver transplantation. Hepatology. 1993 Apr;17(4):605–9.
  29. Saad WE, Davies MG, Saad NE, Waldman DL, Sahler LG, Lee DE, Kitanosono T, Sasson T, Patel NC. Transhepatic dilation of anastomotic biliary strictures in liver transplant recipients with use of a combined cutting and conventional balloon protocol: technical safety and efficacy. J Vasc Interv Radiol. 2006 May;17(5):837–43.
  30. Verdonk RC, Buis CI, van der Jagt EJ, Gouw AS, Limburg AJ, Slooff MJ, Kleibeuker JH, Porte RJ, Haagsma EB. Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression. Liver Transpl. 2007 May;13(5):725–32.
  31. Zajko AB, Campbell WL, Logsdon GA, Bron KM, Tzakis A, Esquivel CO, Starzl TE. Cholangiographic findings in hepatic artery occlusion after liver transplantation. AJR Am J Roentgenol. 1987 Sep;149(3):485–89.
  32. Sanchez-Urdazpal L, Sterioff S, Janes C, Schwerman L, Rosen C, Krom RA. Increased bile duct complications in ABO incompatible liver transplant recipients. Transplant Proc. 1991 Feb;23(1 Pt 2):1440–41.
  33. Sibulesky L, Nguyen JH. Update on biliary strictures in liver transplants. Transplant Proc. 2011 Jun;43(5):1760–64.
  34. Buis CI, Verdonk RC, Van der Jagt EJ, van der Hilst CS, Slooff MJ, Haagsma EB, Porte RJ. Nonanastomotic biliary strictures after liver transplantation, part 1: Radiological features and risk factors for early vs. late presentation. Liver Transpl. 2007 May;13(5):708–18.
  35. Verdonk RC, Buis CI, Porte RJ, van der Jagt EJ, Limburg AJ, van den Berg AP, Slooff MJ, Peeters PM, de Jong KP, Kleibeuker JH, Haagsma EB.
  36. Anastomotic biliary strictures after liver transplantation: causes and consequences. Liver Transpl. 2006 May;12(5):726–35.
  37. Nakamura N, Nishida S, Neff GR, Vaidya A, Levi DM, Kato T, Ruiz P, Tzakis AG, Madariaga JR. Intrahepatic biliary strictures without hepatic artery thrombosis after liver transplantation: an analysis of 1,113 liver transplantations at a single center. Transplantation. 2005 Feb 27;79(4):427–32.
  38. Олисов ОД. Билиарные осложнения после ортотопической трансплантации печени. Трансплантология. 2009;(2):44–51.
  39. Hintze RE, Abou-Rebyeh H, Adler A, Veltzke W, Langrehr J, Wiedenmann B, Neuhaus P. Endoscopic therapy of ischemia-type biliary lesions in patients following orthotopic liver transplantation. Z Gastroenterol. 1999 Jan;37(1):13–20.
  40. Lee HW, Suh KS, Shin WY, Cho EH, Yi NJ, Lee JM, Han JK, Lee KU.
  41. Classification and prognosis of intrahepatic biliary stricture after liver transplantation. Liver Transpl. 2007 Dec;13(12):1736–42.
  42. Sanchez-Urdazpal L, Gores GJ, Ward EM, Maus TP, Wahlstrom HE, Moore SB, Wiesner RH, Krom RA. Ischemic-type biliary complications after orthotopic liver transplantation. Hepatology. 1992 Jul;16(1):49–53.
  43. Skaro AI, Jay CL, Baker TB, Wang E, Pasricha S, Lyuksemburg V, Martin JA, Feinglass JM, Preczewski LB, Abecassis MM. The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story. Surgery. 2009 Oct;146(4):543–52.
  44. De Vera ME, Lopez-Solis R, Dvorchik I, Campos S, Morris W, Demetris AJ, Fontes P, Marsh JW. Liver transplantation using donation after cardiac death donors: long-term follow-up from a single center. Am J Transplant. 2009 Apr;9(4):773–81.
  45. Lang R, He Q, Jin ZK, Han DD, Chen DZ. Urokinase perfusion prevents intrahepatic ischemic-type biliary lesion in donor livers. World J Gastroenterol. 2009 Jul 28;15(28):3538–41.
  46. Inomata Y, Tanaka K. Pathogenesis and treatment of bile duct loss after liver transplantation. J Hepatobiliary Pancreat Surg. 2001;8(4):316–22. Review.
  47. Moench C, Uhrig A, Lohse AW, Otto G. CC chemokine receptor 5delta32 polymorphism-a risk factor for ischemic-type biliary lesions following orthotopic liver transplantation. Liver Transpl. 2004 Mar;10(3):434–39.
  48. Matsumoto Y, McCaughan GW, Painter DM, Bishop GA. Evidence that portal tract microvascular destruction precedes bile duct loss in human liver allograft rejection. Transplantation. 1993 Jul;56(1):69–75.
  49. Schmucker DL, Ohta M, Kanai S, Sato Y, Kitani K. Hepatic injury induced by bile salts: correlation between biochemical and morphological events. Hepatology. 1990 Nov;12(5):1216–21.
  50. Hertl M, Hertl MC, Kluth D, Broelsch CE. Hydrophilic bile salts protect bile duct epithelium during cold preservation: a scanning electron microscopy study. Liver Transpl. 2000 Mar;6(2):207–12.
  51. Geuken E, Visser D, Kuipers F, Blokzijl H, Leuvenink HG, de Jong KP, Peeters PM, Jansen PL, Slooff MJ, Gouw AS, Porte RJ. Rapid increase of bile salt secretion is associated with bile duct injury after human liver transplantation. J Hepatol. 2004 Dec;41(6):1017–25.
Адрес для корреспонденции:
210013, Республика Беларусь, г. Минск, ул. П. Бровки, д. 3, кор. 3, ГУО «Белорусская медицинская академия последипломного образования», кафедра кардиохирургии с курсом трансплантологии,
e-mail: pik-med@tut.by,
Пикиреня Иван Иванович
Cведения об авторах:
Пикиреня И.И., к.м.н., заведующий кафедрой трансплантологии ГУО «Белорусская медицинская академия последипломного образования».
Шарипов Ш.З., аспирант кафедры кардиохирургии с курсом трансплантологии ГУО «Белорусская медицинская академия последипломного образования».
Богушевич О.С., к.м.н., главный хирург Комитета здравоохранения Мингорисполкома.
Контакты | ©Витебский государственный медицинский университет, 2007-2023