Novosti
Khirurgii

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Year 2015 Vol. 23 No 1

TRANSPLANTOLOGY

S.Z. SHARIPOV 2, A.E. SHCHERBA 2, I.I. PIKIRENIA 1, À.À. HLINNIK 1
À.M. FEDARUK 2, S.V. KOROTKOV 2, Î.Î. RUMMO 2

POSSIBILITY OF STREPTOKINASE THERAPY FOR PROPHYLAXIS OF BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION

SEE "Belarusian Medical Academy of Post-Graduate Education"1,
ME "The 9th City Clinical Hospital", Minsk2,
The Republic of Belarus

Objectives. To identify the risk factors for the development of biliary complications after orthotopic liver transplantation and to establish whether streptokinase therapy influences on the formation of biliary complications related liver transplantation in donor phase.
Methods. The analysis of medical records and the treatment results of 117 patients, subjected to the orthotopic liver transplantation within the period from April 2008 to September 2012 has been carried out.
Results. The retrospective analysis has shown the streptokinase treatment in the donor phase does not promote the development of anastomotic biliary strictures. A trend toward a later occurrence of anastomotic strictures after the liver transplantation is considered as a positive effect. The number of the nonanastomotic strictures occurred significantly less during Streptokinase treatment, than in the group without streptokinase application – 2,2% and 13,6%, retrospectively. In the donor phase univariate regression analysis has shown that streptokinase treatment contributed to the risk reduction of nonanastomotic strictures formation almost by 4 folds. The failure of biliary anastomosis occurred in 6 patients out of 117 patients who had undergone the liver transplantation. All of them received a transplant from donors with brain death to whom streptokinase hadn’t been administrated. The average time of failure development – 3 (1; 10) days. Anastomotic strictures related with liver transplantation occurred in 17 patients. Incidence of anastomotic strictures occurrence in the main group was comparable to that in the second group. Thus, in the donor phase streptokinase therapy had no effect on the development of anastomotic strictures. In this case, there was a trend to a later occurrence of anastomotic strictures after transplantation.
Conclusion. The results of the study have shown the effectiveness of the prevention of biliary complications after the liver transplantation by intravenous injections of streptokinase with heparin (dose of 1,5 million IU and 25,000 IU, respectively) 15-20 min before flushing in the donor phase.

Keywords: orthotopic liver transplantation, postoperative complication, biliary stricture, streptokinase
p. 85-90 of the original issue
References
  1. Pascher A, Neuhaus P. Biliary complications after deceased-donor orthotopic liver transplantation. J Hepatobiliary Pancreat Surg. 2006;13(6):487-96.
  2. Wojcicki M, Milkiewicz P, Silva M.Biliary tract complications after liver transplantation: a review. Dig Surg. 2008;25(4):245-57.
  3. Inomata Y, Tanaka K. Pathogenesis and treatment of bile duct loss after liver transplantation. J Hepatobiliary Pancreat Surg. 2001;8(4):316-22.
  4. 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.
  5. Pomposelli JJ, Jenkins RL. 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):1801-802.
  6. Sharma S, Gurakar A, Jabbour N.Biliary strictures following liver transplantation: past, present and preventive strategies. Liver Transpl. 2008 Jun;14(6):759-69.
  7. 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
  8. Moser MA, Wall WJ.Management of biliary problems after liver transplantation. Liver Transpl. 2001 Nov;7(11 Suppl 1):S46-52.
  9. Campbell WL, Sheng R, Zajko AB, Abu-Elmagd K, Demetris AJ.Intrahepatic biliary strictures after liver transplantation. Radiology. 1994 Jun;191(3):735-40.
  10. 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.
  11. Abt P, Crawford M, Desai N, Markmann J, Olthoff K, Shaked A.Liver transplantation from controlled non-heart-beating donors: an increased incidence of biliary complications. Transplantation. 2003 May 27;75(10):1659-63.
  12. Cameron AM, Busuttil RW. Ischemic cholangiopathy after liver transplantation. Hepatobiliary Pancreat Dis Int. 2005 Nov;4(4):495-501.
  13. Foley DP, Fernandez LA, Leverson G, Chin LT, Krieger N, Cooper JT, Shames BD, Becker YT, Odorico JS, Knechtle SJ, Sollinger HW, Kalayoglu M, D'Alessandro AM. Donation after cardiac death: the University of Wisconsin experience with liver transplantation. Ann Surg. 2005 Nov;242(5):724-31.
  14. 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.
  15. Shcherba AE, Korotkov SV, Lebed' OA, Savchuk MM, Dziadz'ko AM, Minov AF, Santotskii EO, Rummo OO. Eksperimental'naia gipotermicheskaia mashinnaia perfuziia transplantatov pecheni rastvorom Kustodiol (HTK) [Experimental hypothermic machine perfusion of the liver transplant by Custodiol solution]. Novosti Khirurgii. 2014;22(1):75-82.
  16. Karimian N, Westerkamp AC, Porte RJ.Biliary complications after orthotopic liver transplantation. Curr Opin Organ Transplant. 2014 Jun;19(3):209-16.
  17. Sankary HN, McChesney L, Frye E, Cohn S, Foster P, Williams J. A simple modification in operative technique can reduce the incidence of nonanastomotic biliary strictures after orthotopic liver transplantation. Hepatology. 1995 Jan;21(1):63-69.
Address for correspondence:
2100, Respublika Belarus,
g. Minsk, ul. Semashko, d. 8,
UZ "9-ya gorodskaya klinicheskaya bolnitsa",
otdelenie khirurgii
tel. mob.: +375 25 612 71 11,
e-mail: shohrat07@mail.ru,
Sharipov Shohrat
Information about the authors:
Sharipov S.Z. A surgeon of the surgical unit of ME "The 9th Clinical Hospital", Minsk.
Shcherba A.E., PhD, a head of the hepatobiliary surgery and liver transplantation unit of ME "The 9th Clinical Hospital", Minsk.
Pikirenia I.I. PhD, an associate professor, a head of the transplantation chair of SEE "Belarusian Medical Academy of Post-graduate Education".
Hlinnik A.A. PhD, an associate professor of the transplantation chair of SEE "Belarusian Medical Academy of Post-graduate Education".
Fedaruk A.M. MD, a head of hepatology and low-invasive surgery unit of ME "The 9th Clinical Hospital", Minsk.
Korotkov S.V. PhD, a head of the transplantation unit of ME "The 9th Clinical Hospital", Minsk.
Rummo O.O. MD, a Deputy Chief on surgery, head of the RSPC of organ and tissue transplantation of ME "The 9th Clinical Hospital", Minsk.
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