Biliary cast syndrome following liver transplantation

Predictive factors and clinical outcomes

Niraj V. Gor, Ronald M. Levy, Joseph Ahn, Dmitriy Kogan, S. Forrest Dodson, Stanley Martin Cohem

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Biliary cast syndrome (BCS), the presence of biliary casts and debris causing biliary obstruction, occurs in 4%-18% of orthotopic liver transplant (OLT) recipients. Potential consequences include cholangitis and graft damage or loss. Limited data exist regarding the etiology and outcomes of BCS. The purpose of this study was to evaluate donor and recipient risk factors and determine the impact of BCS. A retrospective review of 355 OLT cases identified 9 BCS patients (2.5%) diagnosed by cholangiography. Twenty-six matched controls were also identified. The warm ischemic time was significantly longer in BCS patients. Other recipient and donor preoperative and intraoperative characteristics, including the donor risk index, revealed no significant differences. Overall patient survival showed a trend toward worse outcomes at 6, 12, and 18 months and end of follow-up in the BCS group. Overall graft survival was also worse in the BCS group at all time periods, with statistical significance demonstrated at 18 months and end of follow-up. The number of therapeutic billary procedures and hospital readmissions was significantly higher in the BCS group. Twenty-two percent of the BCS patients required repeat OLT versus none of the control patients. In conclusion, BCS is an uncommon complication of OLT. Except for a longer warm ischemic time, recipient and donor factors did not predict the occurrence of BCS. BCS patients showed a significantly worse graft survival, as well as a trend toward worse patient survival. Given the negative impact of BCS on liver transplant outcomes, further studies appear justified.

Original languageEnglish (US)
Pages (from-to)1466-1472
Number of pages7
JournalLiver Transplantation
Volume14
Issue number10
DOIs
StatePublished - 2008
Externally publishedYes

Fingerprint

Superior Mesenteric Artery Syndrome
Liver Transplantation
Transplants
Tissue Donors
Liver
Warm Ischemia
Graft Survival
Patient Readmission
Cholangitis
Survival
Cholangiography

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Hepatology

Cite this

Biliary cast syndrome following liver transplantation : Predictive factors and clinical outcomes. / Gor, Niraj V.; Levy, Ronald M.; Ahn, Joseph; Kogan, Dmitriy; Dodson, S. Forrest; Cohem, Stanley Martin.

In: Liver Transplantation, Vol. 14, No. 10, 2008, p. 1466-1472.

Research output: Contribution to journalArticle

Gor, Niraj V. ; Levy, Ronald M. ; Ahn, Joseph ; Kogan, Dmitriy ; Dodson, S. Forrest ; Cohem, Stanley Martin. / Biliary cast syndrome following liver transplantation : Predictive factors and clinical outcomes. In: Liver Transplantation. 2008 ; Vol. 14, No. 10. pp. 1466-1472.
@article{588bf19ca95c4a57849f118ea0f3f468,
title = "Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes",
abstract = "Biliary cast syndrome (BCS), the presence of biliary casts and debris causing biliary obstruction, occurs in 4{\%}-18{\%} of orthotopic liver transplant (OLT) recipients. Potential consequences include cholangitis and graft damage or loss. Limited data exist regarding the etiology and outcomes of BCS. The purpose of this study was to evaluate donor and recipient risk factors and determine the impact of BCS. A retrospective review of 355 OLT cases identified 9 BCS patients (2.5{\%}) diagnosed by cholangiography. Twenty-six matched controls were also identified. The warm ischemic time was significantly longer in BCS patients. Other recipient and donor preoperative and intraoperative characteristics, including the donor risk index, revealed no significant differences. Overall patient survival showed a trend toward worse outcomes at 6, 12, and 18 months and end of follow-up in the BCS group. Overall graft survival was also worse in the BCS group at all time periods, with statistical significance demonstrated at 18 months and end of follow-up. The number of therapeutic billary procedures and hospital readmissions was significantly higher in the BCS group. Twenty-two percent of the BCS patients required repeat OLT versus none of the control patients. In conclusion, BCS is an uncommon complication of OLT. Except for a longer warm ischemic time, recipient and donor factors did not predict the occurrence of BCS. BCS patients showed a significantly worse graft survival, as well as a trend toward worse patient survival. Given the negative impact of BCS on liver transplant outcomes, further studies appear justified.",
author = "Gor, {Niraj V.} and Levy, {Ronald M.} and Joseph Ahn and Dmitriy Kogan and Dodson, {S. Forrest} and Cohem, {Stanley Martin}",
year = "2008",
doi = "10.1002/lt.21492",
language = "English (US)",
volume = "14",
pages = "1466--1472",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "John Wiley and Sons Ltd",
number = "10",

}

TY - JOUR

T1 - Biliary cast syndrome following liver transplantation

T2 - Predictive factors and clinical outcomes

AU - Gor, Niraj V.

AU - Levy, Ronald M.

AU - Ahn, Joseph

AU - Kogan, Dmitriy

AU - Dodson, S. Forrest

AU - Cohem, Stanley Martin

PY - 2008

Y1 - 2008

N2 - Biliary cast syndrome (BCS), the presence of biliary casts and debris causing biliary obstruction, occurs in 4%-18% of orthotopic liver transplant (OLT) recipients. Potential consequences include cholangitis and graft damage or loss. Limited data exist regarding the etiology and outcomes of BCS. The purpose of this study was to evaluate donor and recipient risk factors and determine the impact of BCS. A retrospective review of 355 OLT cases identified 9 BCS patients (2.5%) diagnosed by cholangiography. Twenty-six matched controls were also identified. The warm ischemic time was significantly longer in BCS patients. Other recipient and donor preoperative and intraoperative characteristics, including the donor risk index, revealed no significant differences. Overall patient survival showed a trend toward worse outcomes at 6, 12, and 18 months and end of follow-up in the BCS group. Overall graft survival was also worse in the BCS group at all time periods, with statistical significance demonstrated at 18 months and end of follow-up. The number of therapeutic billary procedures and hospital readmissions was significantly higher in the BCS group. Twenty-two percent of the BCS patients required repeat OLT versus none of the control patients. In conclusion, BCS is an uncommon complication of OLT. Except for a longer warm ischemic time, recipient and donor factors did not predict the occurrence of BCS. BCS patients showed a significantly worse graft survival, as well as a trend toward worse patient survival. Given the negative impact of BCS on liver transplant outcomes, further studies appear justified.

AB - Biliary cast syndrome (BCS), the presence of biliary casts and debris causing biliary obstruction, occurs in 4%-18% of orthotopic liver transplant (OLT) recipients. Potential consequences include cholangitis and graft damage or loss. Limited data exist regarding the etiology and outcomes of BCS. The purpose of this study was to evaluate donor and recipient risk factors and determine the impact of BCS. A retrospective review of 355 OLT cases identified 9 BCS patients (2.5%) diagnosed by cholangiography. Twenty-six matched controls were also identified. The warm ischemic time was significantly longer in BCS patients. Other recipient and donor preoperative and intraoperative characteristics, including the donor risk index, revealed no significant differences. Overall patient survival showed a trend toward worse outcomes at 6, 12, and 18 months and end of follow-up in the BCS group. Overall graft survival was also worse in the BCS group at all time periods, with statistical significance demonstrated at 18 months and end of follow-up. The number of therapeutic billary procedures and hospital readmissions was significantly higher in the BCS group. Twenty-two percent of the BCS patients required repeat OLT versus none of the control patients. In conclusion, BCS is an uncommon complication of OLT. Except for a longer warm ischemic time, recipient and donor factors did not predict the occurrence of BCS. BCS patients showed a significantly worse graft survival, as well as a trend toward worse patient survival. Given the negative impact of BCS on liver transplant outcomes, further studies appear justified.

UR - http://www.scopus.com/inward/record.url?scp=57849159816&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=57849159816&partnerID=8YFLogxK

U2 - 10.1002/lt.21492

DO - 10.1002/lt.21492

M3 - Article

VL - 14

SP - 1466

EP - 1472

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 10

ER -