Fatores de risco e conduta nas complicações do trato biliar no transplante hepático

Risk factors and management of biliary tract complications in liver transplantation

ARTIGO ORIGINAL

Fatores de risco e conduta nas complicações do trato biliar no transplante hepático

Risk factors and management of biliary tract complications in liver transplantation

Alexandre Coutinho Teixeira de Freitas^I; Júlio Cezar Uili Coelho, TCBC-PR^II; Mônica Beatriz Parolin^I; Jorge Eduardo Fouto Matias^I; Clementino Zeni Neto, TCBC-PR^II; Carolina Gomes Gonçalves^III

^IMédico do Serviço de Transplante Hepático e Cirurgia do Aparelho Digestivo do HC-UFPR

^IIProfessor Titular e Chefe dos Serviços de Transplante Hepático e Cirurgia do Aparelho Digestivo do HC-UFPR

^IIIMonitora dos Serviços de Transplante Hepático e Cirurgia do Aparelho Digestivo do HC-UFPR

^{Endereço para correspondência}

RESUMO

A reconstrução biliar é um dos pontos vulneráveis do transplante hepático apresentando incidência de complicações biliares, variando de 10 a 35%, nos diversos estudos da literatura. Esse trabalho tem por objetivo apresentar a experiência do nosso serviço em relação à incidência e ao manejo das complicações biliares no transplante de fígado. Foram incluídos no estudo 147 transplantes hepáticos ortotópicos, com idade média de 37,3 anos, correspondendo a 88 procedimentos em pacientes do sexo masculino e 59 do sexo feminino. Complicações biliares ocorreram em 27 transplantes (18,36%) em 25 pacientes (dois retransplantes). A presença de rejeição celular e de complicações vasculares foi identificada como fator de risco para as complicações biliares.

A idade, o sexo, a etiologia da cirrose e a técnica utilizada na reconstrução biliar não foram fatores de risco. No total, foram empregados 52 cursos terapêuticos: tratamento cirúrgico em 23 vezes; tratamento endoscópico em 15 vezes; retransplante em sete vezes; drenagem biliar transparieto-hepática em seis vezes e um paciente está em lista de espera para retransplante. Conclui-se deste estudo que as complicações biliares são freqüentes após o transplante hepático e que as vasculares e a rejeição celular são fatores de risco.

Descritores: Transplante hepático; Estenose biliar; Fístula biliar; Complicações biliares; Icterícia.

ABSTRACT

Biliary reconstruction is a vulnerable step of liver transplantation, presenting an incidence of biliary complications between 10 to 35% in many studies. Our aim is to present our incidence and treatment of biliary complications, in a total of 147 orthotopic liver transplantations, 88 males and 59 females, with an mean age of 37 years. Biliary complications occurred in 27 transplants (18,36%) performed in 25 patients (two retransplants). Cellular rejection and vascular complications were identified as risk factors for biliary complications. Age, sex, etiology of cirrhosis and biliary reconstruction technique were not risk factors. Fifty-two therapeutic courses were performed: 23 surgical treatments, 15 endoscopic treatments, seven retransplants, six external biliary drainage and one patient is waiting retransplantation. In conclusion, biliary complications are frequent after liver transplantation and vascular complications and cellular rejection are risk factors for them.

Key words: Hepatic transplantation; Biliary stenosis; Biliary fistula; Biliary complications; Jaundice.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 2/6/2000

Aceito para publicação em 25/8/2000

Trabalho realizado no Serviço de Transplante Hepático do Hospital de Clínicas da Universidade Federal do Paraná – HC-UFPR.

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Endereço para correspondência:

Dr. Júlio Cezar Uili Coelho

Rua Bento Viana, 1140/2202

80240-110 - Curitiba – PR

Fone/Fax: [phone]

Datas de Publicação

• Publicação nesta coleção
  18 Dez 2008
• Data do Fascículo
  Dez 2000

Histórico

• Aceito
  25 Ago 2000
• Recebido
  02 Jun 2000