Clinical Features and Prognosis of Diffuse Intrahepatic Biliary Stricture in Adult ABO-Incompatible Living Donor Liver Transplantation
Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of
Meeting: 2019 American Transplant Congress
Abstract number: D395
Keywords: Graft function, Graft survival, Liver transplantation, Living-related liver donors
Session Information
Date: Tuesday, June 4, 2019
Session Name: Poster Session D: Late Breaking
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Despite the advancement in desensitization protocol, diffuse intrahepatic biliary stricture (DIHBS), an attenuated form of antibody mediated rejection (AMR), remains an unresolved problem. As a high-volume LT center, we retrospectively review clinical outcome and prognosis of recipients who developed DIHBS after ABOi LDLT.
*Methods: From November 2008 to December 2017, total of 497 cases of ABO incompatible LDLT were performed at Asan Medical Center. Among them, twenty-four patients (4.83%) developed DIHBS. Retrospective review of medical records of these patients was carried out.
*Results: Median time of diagnosis for DIHBS after ABOi LDLT was 2.8 months. In patients with DIHBS, the 3-year patient survival rate was 69.9%. Causes of patient death in nine patients were recurrent HCC in four patients, biliary sepsis in two patients, graft failure (not associated with AMR) in one patient, post-operative bleeding after re-LT in one patient, and pneumonia in one patient. Nine patients (37.5%) received re-transplantation. Graft survival rates at 3-year was 40.6%. Both patient survival and graft survival rates were significantly lower than ABOi LDLT recipients without DIHBS (both p< 0.001). Between ABOi LDLT patients with or without DIHBS, there were no significant differences in pre-operative isoagglutinin (IA) titer, post-operative peak bilirubin, AST, ALT, IA titer, and pre- and post-operative frequency of total plasma exchange (TPE). Among the other fifteen patients who are alive, five patients got re-LT, three patients presented mild graft dysfunction with well-functioning PTBD, three patients showed resolution of DIHBS and removed biliary drainage, and four patients demonstrate normal graft function with well-maintained biliary drainage.
*Conclusions: In this study, DIHBS developed usually before 3 months after ABOi LDLT. DIHBS significantly affects short and long-term outcome in ABOi LDLT. In patients who demonstrated DIHBS, over half of the patient progress to graft failure and needed re-LT.
To cite this abstract in AMA style:
Kwon J, Song G, Hwang S, Kim K, Ahn C, Moon D, Ha T, Jung D, Park G, Yoon Y, Cho H, Jeong I, Choi J, Yoo S, Lee S. Clinical Features and Prognosis of Diffuse Intrahepatic Biliary Stricture in Adult ABO-Incompatible Living Donor Liver Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-features-and-prognosis-of-diffuse-intrahepatic-biliary-stricture-in-adult-abo-incompatible-living-donor-liver-transplantation/. Accessed March 1, 2021.« Back to 2019 American Transplant Congress