Vries, A.B. de (2012) Clinical Impact of Non-Anastomotic Biliary Strictures After Liver Transplantation : Effects on Health Care Consumption, Use of Ionizing Radiation, Infectious Events and Antibiotic Use. thesis, Medicine.
Full text available on request.Abstract
Introduction: Non-anastomotic biliary strictures (NAS) are a frequent complication seen after liver transplantation for which the exact pathogenesis is still unknown. NAS can be classified as a heterogeneous group of biliary strictures varying in anatomical location and severity. NAS can manifest itself in the intra- and extra-hepatic bile ducts and can comprise a single or multiple strictures. Development of NAS after liver transplantation often results in cholestasis, jaundice, recurrent cholangitis and billiary cirrhosis. Objective: Non-anastomotic biliary strictures after orthotopic liver transplantation (OLT) have a negative influence on graft survival. Impact of NAS on other important aspects of post-transplant care is largely unknown. Aim of this study was to determine the impact of NAS on healthcare consumption, radiation exposure, infectious events and antibiotic use. Patients and methods: Data was retrospectively collected from medical records of patients undergoing OLT at the University Medical Center Groningen between 1999 and 2009. Patients with NAS were included. Children and patients with NAS due to hepatic artery thrombosis were excluded. Factors associated with health care consumption, use of ionizing radiation, antibiotic therapy, infectious complications and development of multiresistant microorganisms were studied. NAS patients were compared with a control group matched for age, indication for and year of transplantation. Results: 86 patients were reviewed, 43 liver recipients with NAS and 43 control liver recipients. Both total admissions and frequency per patient were significantly higher in the group with NAS. For interventional procedures both percutaneous transhepatic cholangiography and endoscopic retrograde cholangiopancreaticography were significantly increased in the NAS group in comparison to the control group. With the exception of computed tomography, radiological studies were increased in the NAS group resulting in a significantly higher amount of ionizing radiation received. The amount of positive bacterial blood and bile cultures was higher in the group with NAS and results showed more development of multiresistant microorganisms. Patients with non-anastomotic strictures experienced more episodes of bacterial cholangitis and were more often treated with antibiotics, both therapeutically and prophylactically. Conclusions: Development of non-anastomotic biliary strictures after liver transplantation has a negative effect on several important post-transplant care aspects that were not previously studied. We found an increase in readmission rates, interventional procedures, exposure to ionizing radiation, use of antibiotics and development of multiresistant microorganisms, contributing to patient morbidity, burden and additional healthcare costs.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Verdonk, R.C. MD and Koornstra, J.J. MD |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/644 |
Actions (login required)
 |
View Item |