Bile duct stones and casts after liver transplantation: Different entities but similar prevention strategy?

✍ Scribed by Umberto Cillo; Patrizia Burra; Lorenzo Norberto; Davide D'Amico

• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 73 KB
• Volume: 14
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21628

✦ Synopsis

Taken together, sludge, casts and stones, even though rare, represent the third cause of biliary complications after liver transplantation (LT). Prevalence was reported at 6% in a Pittsburgh 13-year-period study focusing on cholangiographic evidence of bile duct filling defects post-orthotopic LT (post-OLT), but prevalence reached 18% in other reports. 1 Most early studies on the topic, mainly represented by case or small cohort reports, were carried out before 1980, 2-5 whereas more recent works include relatively larger case-control series, which often did not discriminate among stones, sludge, debris, and casts.

As a final pathological event, all these intrabiliary concretions may cause biliary obstruction, bile stasis, and infection, as well as hepatocyte and ductal damage, leading to an "overt" cholangiopathy.

However, even though strong scientific evidence is missing in the field, there are good grounds to consider these concretions as different entities; at least from the pathophysiologic point of view. 6-8 Such a distinction, in fact, may have important implications in the interpretation of the scientific data published, which often presents conflicting results.

Granted that the presence of a complex and dynamic multifactorial framework is essential, two dominant pathogenetic frames seem to be identifiable. The first frame is more associated with diffuse cast and debris formation, the second frame with stones and strictureassociated casts, with a wide possibility of overlaps.