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Graft cholangiopathy: etiology, diagnosis, and therapeutic strategies |
Ying Luo, Wen-Bin Ji, Wei-Dong Duan, Sheng Ye and Jia-Hong Dong |
Beijing, China
Author Affiliations: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China (Luo Y, Ji WB, Duan WD, Ye S and Dong JH)
Corresponding Author: Jia-Hong Dong, MD, Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (Tel: 86-10-66938030; Fax: 86-10-68241383; Email: dongjh301@163.com) |
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Abstract BACKGROUND: Graft cholangiopathy has been recognized as a significant cause of morbidity, graft loss, and even mortality in patients after orthotopic liver transplantation. The aim of this review is to analyze the etiology, pathogenesis, diagnosis and therapeutic strategies of graft cholangiopathy after liver transplantation.
DATA SOURCE: A PubMed database search was performed to identify articles relevant to liver transplantation, biliary complications and cholangiopathy.
RESULTS: Several risk factors for graft cholangiopathy after liver transplantation have been identified, including ischemia/reperfusion injury, cytomegalovirus infection, immunological injury and bile salt toxicity. A number of strategies have been attempted to prevent the development of graft cholangiopathy, but their efficacy needs to be evaluated in large clinical studies. Non-surgical approaches may offer good results in patients with extrahepatic lesions. For most patients with complex hilar and intrahepatic biliary abnormalities, however, surgical repair or re-transplantation may be required.
CONCLUSIONS: The pathogenesis of graft cholangiopathy after liver transplantation is multifactorial. In the future, more efforts should be devoted to the development of more effective preventative and therapeutic strategies against graft cholangiopathy.
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