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Prognostic Factors for Non-anastomotic Biliary Strictures Following Adult Liver Transplantation: A Systematic Review and Meta-Analysis

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Abstract

Introduction

The development of non-anastomotic biliary strictures (NAS) following orthotopic adult liver transplantation (OLT) is associated with significant morbidity. We performed a systematic review and meta-analysis to identify all prognostic factors for the development of NAS.

Methods

A systematic review was conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) and the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. We used the Newcastle–Ottawa scale to assess the quality of the included studies. Using the random-effects model, we calculated the weighted pooled odds ratios (OR), mean differences (MD), hazard ratios (HR), and 95% confidence intervals (CI) of the risk factors.

Results

Based on 19 international studies that included a total of 8269 adult LT patients, we calculated an 8% overall incidence of NAS. In this study, 7 potential prognostic factors were associated with a statistically significant hazard ratio for NAS in pooled analyses including (1) DCD donors compared to DBD donors (2) PSC as an indication for a liver transplant (3) Roux-en-Y bile duct reconstruction compared to duct-to-duct reconstruction (4) hepatic artery thrombosis (5) longer cold ischemia time (6) longer warm ischemia time (7) and total operative times.

Conclusion

In this systematic review and meta-analysis, we identified 7 prognostic factors for the development of NAS following OLT. These findings might lay the groundwork for development of diagnostic algorithms to better risk stratify patients at risk for development of NAS.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, New York University (NYU) Medical Center, 550 1st Avenue, New York, NY, 10016, USA

    Matthew Fasullo, Tamas Gonda, Eileen Janec, Lauren Khanna & Gregory Haber

  2. Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, USA

    Sami Ghazaleh & Wasef Sayeh

  3. Division of Gastroenterology and Hepatology, Virginia Commonwealth University (VCU) Medical Center, 1250 E Marshall Street, Richmond, VA, 23298, USA

    Ravi Vachhani & Tilak Shah

  4. Division of Gastroenterology, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, 11203, USA

    Tamta Chkhikvadze

  5. Division of Gastroenterology and Hepatology, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd, Richmond, VA, 23249, USA

    Tilak Shah

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Contributions

MF: conception and design; analysis and interpretation of the data; drafting of the article; critical revision of the article for important intellectual content; final approval of the article. SG: conception and design; critical revision of the article for important intellectual content; final approval of the article. WS: conception and design; analysis and interpretation of the data; drafting of the article; critical revision of the article for important intellectual content; final approval of the article. RV: analysis and interpretation of the data; critical revision of the article for important intellectual content; final approval of the article. TC: analysis and interpretation of the data; critical revision of the article for important intellectual content; final approval of the article. TG: analysis and interpretation of the data; critical revision of the article for important intellectual content; final approval of the article. EJ: conception and design; critical revision of the article for important intellectual content; final approval of the article. LK: critical revision of the article for important intellectual content; final approval of the article. Gregory Haber: critical revision of the article for important intellectual content; final approval of the article. TS: conception and design; critical revision of the article for important intellectual content; final approval of the article.

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Correspondence to Matthew Fasullo.

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Fasullo, M., Ghazaleh, S., Sayeh, W. et al. Prognostic Factors for Non-anastomotic Biliary Strictures Following Adult Liver Transplantation: A Systematic Review and Meta-Analysis. Dig Dis Sci 68, 2683–2694 (2023). https://doi.org/10.1007/s10620-023-07861-0

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