tailieunhanh - Liver Transplantation - part 8

Đây là những thường được phân loại như anastomotic hay không anastomotic; anastomotic phổ biến nhất. Anastomotic hẹp không có thể được gây ra bởi thời gian dài ấm áp thiếu máu cục bộ trong quá trình phẫu thuật cấy ghép hoặc do huyết khối của các gốc động mạch gan | 7 If these investigations are normal a liver biopsy is necessary to exclude chronic ductopenic rejection Biliary Leaks These occur because of ischemic necrosis at the anastomosis or following removal of a T-tube. Bile Duct Strictures These are usually classified as anastomotic or non-anastomotic anastomotic being most common. Non-anastomotic strictures may be caused by long warm ischemic times during transplant surgery or by thrombosis of hepatic artery radicals ischemic cholangiopathy they are associated with ABO mismatches and are a feature of recurrent PSC see Chapter 8 . Bile leaks that heal spontaneously may result in anastomotic stricturing. Biliary leaks following the removal of a T-tube are best stented via the endoscopic or percutaneous route. Anastomotic strictures usually require surgical reconstruction with excision of the stricture and re-anastomosis to a Roux loop of jejunum. Stenting may be palliative in selected cases. The Biliary Cast Syndrome Associated with biliary stricture formation and ischemic injury to the biliary tree. May be more common with non-heart beating donors . In addition to strictures the extrahepatic and ultimately the intrahepatic biliary trees are clogged with cast material sludge. Cholesterol is the main component of biliary cast matter Presents with intractable pruritus Managed by serial removal of biliary cast material sludge by ERC or by percutaneous cholangiography May require retransplantation Recurrence of Disease After Liver Transplantation Recurrence of disease following liver transplantation remains a problem for the long-term survivor in several indications and may affect graft function and survival. It does however provide useful information about the pathogenesis of the underlying disease process. Recurrent disease is described in Chapter 8. Suggested Reading 1. Demetris AJ Batts KP Dhillon AP et al. Banff scheme for grading liver allograft rejection an international consensus document. Hepatology 1997 25 658-663.