© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Transplant Infectious Disease, ISSN 1398-2273
Case report
Rare cause of jaundice in a post liver transplant patient W.H. She, K.S.H. Chok, R.C.L. Lo, S.C. Chan, C.M. Lo. Rare cause of jaundice in a post liver transplant patient. Transpl Infect Dis 2015: 17: 579–582. All rights reserved Abstract: A hepatitis B virus carrier suffering from acute flare of chronic hepatitis B infection underwent deceased-donor liver transplantation. He was put on the immunosuppressive agent tacrolimus. On routine follow-up, he was found to have abnormal liver function. Computed tomography scan of the abdomen did not show any dilatation of the biliary system. Liver biopsy showed scattered microabscesses, and a microgranuloma was detected. Endoscopic retrograde cholangiography was performed and a biliary anastomotic stricture (BAS) was noted. In addition, the Chinese liver fluke, Clonorchis sinensis, was discovered. Balloon dilatation and stenting were performed. The patient was given a course of praziquantel. His liver function improved and normalized. We present the case of a liver transplant recipient with cholangitis caused by C. sinensis infestation and infection and biliary obstruction resulting from BAS.
W.H. She1, K.S.H. Chok1, R.C.L. Lo2, S.C. Chan1, C.M. Lo1 1
Division of Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China, 2Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China Key words: Clonorchis sinensis; deceased-donor liver transplantation; biliary anastomotic stricture Correspondence to: Dr. Kenneth S. H. Chok, 102 Pok Fu Lam Road, Hong Kong, China Tel: (852) 22553025 Fax: (852) 28165284 E-mail: [email protected]
Received 1 January 2015, revised 8 March 2015, 18 April 2015, accepted for publication 7 June 2015 DOI: 10.1111/tid.12414 Transpl Infect Dis 2015: 17: 579–582
Jaundice in liver transplant recipients can have various causes. Common differential diagnoses include surgical complications (e.g., intra-abdominal collection, biloma), medical complications (e.g., acute rejection), inadequate control of hepatitis, and delayed graft function. Delayed presentation of jaundice can be the result of acute or chronic rejection, hepatitis flare-up, or biliary complication such as biliary anastomotic stricture (BAS). It is estimated that 15–20 million people are infected with the Chinese liver fluke, Clonorchis sinensis, globally (1). C. sinensis is endemic to China, with a 0.58% infection rate (2) and 12.5 million infected people (3). C. sinensis is also common in Vietnam, Korea, and Russia, with at least 1–1.3 million people infected in these countries, respectively (4–6). Given the large infected population, it is possible that some liver donors are infected with C. sinensis. Herein, we report a patient who had jaundice 5 months after decreased-donor liver transplantation. He was diagnosed as having BAS and C. sinensis.
Case A hepatitis B virus carrier suffering from acute flare of chronic hepatitis B underwent deceased-donor liver transplantation in April 2014. The pathological finding was acute-on-chronic hepatitis with cirrhosis. He suffered from post-transplant left soleal venous thrombosis and completed a course of anticoagulant. He was put on tacrolimus as the sole immunosuppressive agent. On routine follow-up 5 months after transplantation, he was found to have abnormal liver function studies: alkaline phosphatase at 134 U/L, alanine aminotransferase at 641 U/L, aspartate aminotransferase at 328 U/L, and gamma-glutamyl transferase at 456 U/L. He tested negative for hepatitis B surface antigen. Computed tomographic scan of the abdomen did not show any definite dilatation of the common bile duct or intrahepatic ducts. Liver biopsy was performed and suggested moderate lymphohistiocytic infiltration with a small number of neutrophils and occasional eosinophils (Fig. 1).
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She et al: Rare cause of jaundice
A
Fig. 1. Liver biopsy revealed no evidence of acute or chronic cellular rejection.
Scattered microabscesses were also seen, and a microgranuloma was detected in the liver parenchyma. Endoscopic retrograde cholangiography (ERC) was performed. A BAS was noted (Fig. 2A). Despite a >50% stenotic segment, free flow of contrast into the intrahepatic biliary system was observed, and the cannula was able to pass through easily. However, in addition to the stricture, C. sinensis was discovered (Fig. 3). Balloon dilatation using Quantum TTC 6 mm biliary balloon dilator (Cook Medical, Bloomington, Indiana, USA) at 8 atmospheres for 3 min, and stenting with Fr 7–7 cm double pigtail Zimmon biliary stent (Cook Medical) were performed (Fig. 2B–C). The patient was given a course of praziquantel 1500 mg 3 times a day (tds) for 2 days (25 mg/kg per oral tds for 2 days). His liver function improved and normalized. Examination of the stool with microscopy for ova and cyst showed negative results.
B
Discussion Jaundice is not uncommon in liver transplant recipients. Common causes include postoperative bile leakage and biloma, acute hepatitis with various causes, acute or chronic cellular rejection of the liver graft, biliary complication (e.g., common bile duct stones, BAS), and re-emergence of the underlying autoimmune condition (e.g., primary sclerosing cholangitis, primary biliary cirrhosis). Confirmatory tests would depend on the patient’s underlying condition and presentation. Ultrasonography, computed tomography scan, and magnetic resonance imaging of the abdomen might illustrate the
580
C Fig. 2. (A) Cholangiography showed a biliary anastomotic stricture. (B) Balloon dilatation of the stricture. (C) The stricture after dilatation.
presence of intra-abdominal collection, a dilated ductal system, or common bile duct stones. Liver biopsy would be necessary to delineate the underlying graft problem, be it rejection, hepatitis, or ductal obstruction;
Transplant Infectious Disease 2015: 17: 579–582
She et al: Rare cause of jaundice
Fig. 3. Endoscopic view of the Clonorchis sinensis.
however, biopsy is an invasive procedure. ERC might be necessary for the detection of BAS or ductal obstruction, as the graft bile duct might not be dilated on imaging if it is stenotic (7). Our patient underwent liver biopsy and ERC. Cholangiography revealed a BAS of >50%. After dilatation, the stricture improved. Attempted trawling of the bile duct with balloon catheter yielded a C. sinensis fluke; a plastic stent was deployed. The patient was treated with a course of praziquantel. His liver function improved, and further sessions of ERC with dilatation were scheduled. BAS and C. sinensis could both have contributed to the patient’s jaundice; it is difficult to know which had contributed more to the symptoms. It could be that the C. sinensis was stuck at the stricture, while the stricture was gradually developing, resulting in obstructive jaundice and cholangitis. C. sinensis is widely found in East Asia (8). It requires 3 different hosts for completion of its life cycle: snail, fish, and mammal. When a human ingests raw freshwater fish that has become a host, C. sinensis migrates into the biliary tree through the duodenum and matures into an adult after reaching the intrahepatic bile duct (1). To minimize the risk of C. sinensis infection, raw fish intake should be avoided. C. sinensis and humans are well adapted to each other, and most infected humans show no symptoms at all. Only some heavily infected patients might present with epigastric pain, fever, jaundice, or diarrhea. Remote complications include recurrent pyogenic cholangitis and cholangiocarcinoma (9). It is very difficult to diagnose infected potential liver donors. Zhu et al. (10) reported 14 liver transplant patients, receiving livers from deceased donors, who
were all asymptomatic of clonorchiasis and showed no laboratory evidence of abnormal liver function, but dead liver flukes were found in their bile after liver procurement, and clonorchiasis was later confirmed by pathological examination. Praziquantel is an effective chemotherapeutic agent with a high cure rate (83%) and egg reduction rate (99%) (11, 12). The use of C. sinensis-infested liver grafts has been reported and proven to be safe, and these grafts do not entail worse graft outcomes (10, 13–16). Recipients usually fare well with good graft function and no major complications. This fact is important in the face of severe shortage of liver donations. Identification of C. sinensis infection in liver donors is usually made when live C. sinensis flukes are flushed out with bile during donor hepatectomy, or when dead C. sinensis is found in the biliary perfusate at the back table (10). During the period of cool ischemia, the C. sinensis is probably killed (10, 14). In our present case, C. sinensis was not detected during graft procurement or in the back-table procedure. The patient was transplanted and subsequently presented with cholangitis in a delayed manner. This case demonstrated a rare presentation of jaundice in a liver transplant recipient, where the diagnosis could only be made with ERC and with the evidence of C. sinensis. The C. sinensis might have been present in the liver graft before the transplantation, which was not killed during cool ischemia or flushed out during the back-table procedure, or it might have been present in the patient before the transplantation. Aside from the C. sinensis, BAS also contributed to the patient’s jaundice and abnormal liver function. BAS has different causes, but it is commonly attributed to flawed surgical technique, arterial complications, local ischemia of the donor bile duct, or bile leakage. BAS is usually treated by ERC (in the case of duct-to-duct anastomosis) (17–19) or percutaneous transhepatic dilatation (in the case of hepaticojejunostomy) (19–21). Serial dilatation has been shown to be effective in management of the BAS. However, when endoscopic or percutaneous treatment fails, surgical intervention in terms of redo hepaticojejunostomy should be considered (19).
Conclusion We report a case of late presentation of abnormal liver function in a deceased-donor liver transplant recipient diagnosed with BAS and C. sinensis infection. Treatment with endoscopic biliary dilatation and praziquantel was successful in this patient.
Transplant Infectious Disease 2015: 17: 579–582
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She et al: Rare cause of jaundice
Acknowledgements: Funding: No funding was received for the study or its publication. Conflicts: None of the authors has any conflict of interest with regard to the study or its publication.
References 1. Hong ST, Fang Y. Clonorchis sinensis and clonorchiasis, an update. Parasitol Int 2012; 61 (1): 17–24. 2. Coordinating Office of the National Survey on the Important Human Parasitic D. [A national survey on current status of the important parasitic diseases in human population]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi (Chinese J Parasitol Parasitic Dis) 2005; 23 (5 Suppl): 332–340. 3. Fang YY, Chen YD, Li XM, Wu J, Zhang QM, Ruan CW. [Current prevalence of Clonorchis sinensis infection in endemic areas of China]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi (Chinese J Parasitol Parasitic Dis) 2008; 26 (2): 99–103, 109. 4. Dang TC, Yajima A, Nguyen VK, Montresor A. Prevalence, intensity and risk factors for clonorchiasis and possible use of questionnaires to detect individuals at risk in northern Vietnam. Trans R Soc Trop Med Hyg 2008; 102 (12): 1263–1268. 5. Figurnov VA, Chertov AD, Romanenko NA, et al. Clonorchiasis in the Upper Amur region: biology, epidemiology, clinical presentation. Med Parazitol (Mosk) 2002; 4: 20–23. 6. Kim TS, Cho SH, Huh S, et al. A nationwide survey on the prevalence of intestinal parasitic infections in the Republic of Korea, 2004. Korean J Parasitol 2009; 47 (1): 37–47. 7. Chok KS, Lo CM. Prevention and management of biliary anastomotic stricture in right-lobe living-donor liver transplantation. J Gastroenterol Hepatol 2014; 29 (10): 1756–1763. 8. Rim HJ. Clonorchiasis: an update. J Helminthol 2005; 79 (3): 269–281.
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9. Choi MH, Park SK, Li Z, et al. Effect of control strategies on prevalence, incidence and re-infection of clonorchiasis in endemic areas of China. PLoS Negl Trop Dis 2010; 4 (2): e601. 10. Zhu ZJ, Shen ZY, Gao W, et al. Feasibility of using a liver infected with Clonorchis sinensis for liver transplantation: fourteen cases. Liver Transplant 2010; 16 (12): 1440–1442. 11. Rim HJ. [The current pathobiology and chemotherapy of clonorchiasis]. Kisaengchunghak Chapchi (Korean J Parasitol) 1986; 24 (Suppl): 1–141. 12. Chai JY. Praziquantel treatment in trematode and cestode infections: an update. Infect Chemother 2013; 45 (1): 32–43. 13. Ho JK, Lau WY, Liu K, et al. Liver infested with Clonorchis sinensis in orthotopic liver transplantation: a case report. Transplant Proc 1994; 26 (4): 2269–2271. 14. Yeung CK, Ho JK, Lau WY, Lee KH, Li AK. The use of liver grafts infested with Clonorchis sinensis for orthotopic liver transplantation. Postgrad Med J 1996; 72 (849): 427–428. 15. Hwang YJ, Kim YI, Yun YK, Kim JW. Use of liver graft infested with Clonorchis sinensis for living related liver transplantation: a case report. Transplant Proc 2000; 32 (7): 2182–2183. 16. Lee KW, Joh JW, Kim SJ, et al. Living donor liver transplantation using graft infested with Clonorchis sinensis: two cases. Transplant Proc 2003; 35 (1): 66–67. 17. Mahajani RV, Cotler SJ, Uzer MF. Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation. Endoscopy 2000; 32 (12): 943–949. 18. Buxbaum JL, Biggins SW, Bagatelos KC, Ostroff JW. Predictors of endoscopic treatment outcomes in the management of biliary problems after liver transplantation at a high-volume academic center. Gastrointest Endosc 2011; 73 (1): 37–44. 19. Chok KS, Chan SC, Cheung TT, et al. A retrospective study on risk factors associated with failed endoscopic treatment of biliary anastomotic stricture after right-lobe living donor liver transplantation with duct-to-duct anastomosis. Ann Surg 2014; 259 (4): 767–772. 20. Thuluvath PJ, Pfau PR, Kimmey MB, Ginsberg GG. Biliary complications after liver transplantation: the role of endoscopy. Endoscopy 2005; 37 (9): 857–863. 21. Weber A, Prinz C, Gerngross C, et al. Long-term outcome of endoscopic and/or percutaneous transhepatic therapy in patients with biliary stricture after orthotopic liver transplantation. J Gastroenterol 2009; 44 (12): 1195–1202.
Transplant Infectious Disease 2015: 17: 579–582
Case report
Rare cause of jaundice in a post liver transplant patient W.H. She, K.S.H. Chok, R.C.L. Lo, S.C. Chan, C.M. Lo. Rare cause of jaundice in a post liver transplant patient. Transpl Infect Dis 2015: 17: 579–582. All rights reserved Abstract: A hepatitis B virus carrier suffering from acute flare of chronic hepatitis B infection underwent deceased-donor liver transplantation. He was put on the immunosuppressive agent tacrolimus. On routine follow-up, he was found to have abnormal liver function. Computed tomography scan of the abdomen did not show any dilatation of the biliary system. Liver biopsy showed scattered microabscesses, and a microgranuloma was detected. Endoscopic retrograde cholangiography was performed and a biliary anastomotic stricture (BAS) was noted. In addition, the Chinese liver fluke, Clonorchis sinensis, was discovered. Balloon dilatation and stenting were performed. The patient was given a course of praziquantel. His liver function improved and normalized. We present the case of a liver transplant recipient with cholangitis caused by C. sinensis infestation and infection and biliary obstruction resulting from BAS.
W.H. She1, K.S.H. Chok1, R.C.L. Lo2, S.C. Chan1, C.M. Lo1 1
Division of Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China, 2Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China Key words: Clonorchis sinensis; deceased-donor liver transplantation; biliary anastomotic stricture Correspondence to: Dr. Kenneth S. H. Chok, 102 Pok Fu Lam Road, Hong Kong, China Tel: (852) 22553025 Fax: (852) 28165284 E-mail: [email protected]
Received 1 January 2015, revised 8 March 2015, 18 April 2015, accepted for publication 7 June 2015 DOI: 10.1111/tid.12414 Transpl Infect Dis 2015: 17: 579–582
Jaundice in liver transplant recipients can have various causes. Common differential diagnoses include surgical complications (e.g., intra-abdominal collection, biloma), medical complications (e.g., acute rejection), inadequate control of hepatitis, and delayed graft function. Delayed presentation of jaundice can be the result of acute or chronic rejection, hepatitis flare-up, or biliary complication such as biliary anastomotic stricture (BAS). It is estimated that 15–20 million people are infected with the Chinese liver fluke, Clonorchis sinensis, globally (1). C. sinensis is endemic to China, with a 0.58% infection rate (2) and 12.5 million infected people (3). C. sinensis is also common in Vietnam, Korea, and Russia, with at least 1–1.3 million people infected in these countries, respectively (4–6). Given the large infected population, it is possible that some liver donors are infected with C. sinensis. Herein, we report a patient who had jaundice 5 months after decreased-donor liver transplantation. He was diagnosed as having BAS and C. sinensis.
Case A hepatitis B virus carrier suffering from acute flare of chronic hepatitis B underwent deceased-donor liver transplantation in April 2014. The pathological finding was acute-on-chronic hepatitis with cirrhosis. He suffered from post-transplant left soleal venous thrombosis and completed a course of anticoagulant. He was put on tacrolimus as the sole immunosuppressive agent. On routine follow-up 5 months after transplantation, he was found to have abnormal liver function studies: alkaline phosphatase at 134 U/L, alanine aminotransferase at 641 U/L, aspartate aminotransferase at 328 U/L, and gamma-glutamyl transferase at 456 U/L. He tested negative for hepatitis B surface antigen. Computed tomographic scan of the abdomen did not show any definite dilatation of the common bile duct or intrahepatic ducts. Liver biopsy was performed and suggested moderate lymphohistiocytic infiltration with a small number of neutrophils and occasional eosinophils (Fig. 1).
579
She et al: Rare cause of jaundice
A
Fig. 1. Liver biopsy revealed no evidence of acute or chronic cellular rejection.
Scattered microabscesses were also seen, and a microgranuloma was detected in the liver parenchyma. Endoscopic retrograde cholangiography (ERC) was performed. A BAS was noted (Fig. 2A). Despite a >50% stenotic segment, free flow of contrast into the intrahepatic biliary system was observed, and the cannula was able to pass through easily. However, in addition to the stricture, C. sinensis was discovered (Fig. 3). Balloon dilatation using Quantum TTC 6 mm biliary balloon dilator (Cook Medical, Bloomington, Indiana, USA) at 8 atmospheres for 3 min, and stenting with Fr 7–7 cm double pigtail Zimmon biliary stent (Cook Medical) were performed (Fig. 2B–C). The patient was given a course of praziquantel 1500 mg 3 times a day (tds) for 2 days (25 mg/kg per oral tds for 2 days). His liver function improved and normalized. Examination of the stool with microscopy for ova and cyst showed negative results.
B
Discussion Jaundice is not uncommon in liver transplant recipients. Common causes include postoperative bile leakage and biloma, acute hepatitis with various causes, acute or chronic cellular rejection of the liver graft, biliary complication (e.g., common bile duct stones, BAS), and re-emergence of the underlying autoimmune condition (e.g., primary sclerosing cholangitis, primary biliary cirrhosis). Confirmatory tests would depend on the patient’s underlying condition and presentation. Ultrasonography, computed tomography scan, and magnetic resonance imaging of the abdomen might illustrate the
580
C Fig. 2. (A) Cholangiography showed a biliary anastomotic stricture. (B) Balloon dilatation of the stricture. (C) The stricture after dilatation.
presence of intra-abdominal collection, a dilated ductal system, or common bile duct stones. Liver biopsy would be necessary to delineate the underlying graft problem, be it rejection, hepatitis, or ductal obstruction;
Transplant Infectious Disease 2015: 17: 579–582
She et al: Rare cause of jaundice
Fig. 3. Endoscopic view of the Clonorchis sinensis.
however, biopsy is an invasive procedure. ERC might be necessary for the detection of BAS or ductal obstruction, as the graft bile duct might not be dilated on imaging if it is stenotic (7). Our patient underwent liver biopsy and ERC. Cholangiography revealed a BAS of >50%. After dilatation, the stricture improved. Attempted trawling of the bile duct with balloon catheter yielded a C. sinensis fluke; a plastic stent was deployed. The patient was treated with a course of praziquantel. His liver function improved, and further sessions of ERC with dilatation were scheduled. BAS and C. sinensis could both have contributed to the patient’s jaundice; it is difficult to know which had contributed more to the symptoms. It could be that the C. sinensis was stuck at the stricture, while the stricture was gradually developing, resulting in obstructive jaundice and cholangitis. C. sinensis is widely found in East Asia (8). It requires 3 different hosts for completion of its life cycle: snail, fish, and mammal. When a human ingests raw freshwater fish that has become a host, C. sinensis migrates into the biliary tree through the duodenum and matures into an adult after reaching the intrahepatic bile duct (1). To minimize the risk of C. sinensis infection, raw fish intake should be avoided. C. sinensis and humans are well adapted to each other, and most infected humans show no symptoms at all. Only some heavily infected patients might present with epigastric pain, fever, jaundice, or diarrhea. Remote complications include recurrent pyogenic cholangitis and cholangiocarcinoma (9). It is very difficult to diagnose infected potential liver donors. Zhu et al. (10) reported 14 liver transplant patients, receiving livers from deceased donors, who
were all asymptomatic of clonorchiasis and showed no laboratory evidence of abnormal liver function, but dead liver flukes were found in their bile after liver procurement, and clonorchiasis was later confirmed by pathological examination. Praziquantel is an effective chemotherapeutic agent with a high cure rate (83%) and egg reduction rate (99%) (11, 12). The use of C. sinensis-infested liver grafts has been reported and proven to be safe, and these grafts do not entail worse graft outcomes (10, 13–16). Recipients usually fare well with good graft function and no major complications. This fact is important in the face of severe shortage of liver donations. Identification of C. sinensis infection in liver donors is usually made when live C. sinensis flukes are flushed out with bile during donor hepatectomy, or when dead C. sinensis is found in the biliary perfusate at the back table (10). During the period of cool ischemia, the C. sinensis is probably killed (10, 14). In our present case, C. sinensis was not detected during graft procurement or in the back-table procedure. The patient was transplanted and subsequently presented with cholangitis in a delayed manner. This case demonstrated a rare presentation of jaundice in a liver transplant recipient, where the diagnosis could only be made with ERC and with the evidence of C. sinensis. The C. sinensis might have been present in the liver graft before the transplantation, which was not killed during cool ischemia or flushed out during the back-table procedure, or it might have been present in the patient before the transplantation. Aside from the C. sinensis, BAS also contributed to the patient’s jaundice and abnormal liver function. BAS has different causes, but it is commonly attributed to flawed surgical technique, arterial complications, local ischemia of the donor bile duct, or bile leakage. BAS is usually treated by ERC (in the case of duct-to-duct anastomosis) (17–19) or percutaneous transhepatic dilatation (in the case of hepaticojejunostomy) (19–21). Serial dilatation has been shown to be effective in management of the BAS. However, when endoscopic or percutaneous treatment fails, surgical intervention in terms of redo hepaticojejunostomy should be considered (19).
Conclusion We report a case of late presentation of abnormal liver function in a deceased-donor liver transplant recipient diagnosed with BAS and C. sinensis infection. Treatment with endoscopic biliary dilatation and praziquantel was successful in this patient.
Transplant Infectious Disease 2015: 17: 579–582
581
She et al: Rare cause of jaundice
Acknowledgements: Funding: No funding was received for the study or its publication. Conflicts: None of the authors has any conflict of interest with regard to the study or its publication.
References 1. Hong ST, Fang Y. Clonorchis sinensis and clonorchiasis, an update. Parasitol Int 2012; 61 (1): 17–24. 2. Coordinating Office of the National Survey on the Important Human Parasitic D. [A national survey on current status of the important parasitic diseases in human population]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi (Chinese J Parasitol Parasitic Dis) 2005; 23 (5 Suppl): 332–340. 3. Fang YY, Chen YD, Li XM, Wu J, Zhang QM, Ruan CW. [Current prevalence of Clonorchis sinensis infection in endemic areas of China]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi (Chinese J Parasitol Parasitic Dis) 2008; 26 (2): 99–103, 109. 4. Dang TC, Yajima A, Nguyen VK, Montresor A. Prevalence, intensity and risk factors for clonorchiasis and possible use of questionnaires to detect individuals at risk in northern Vietnam. Trans R Soc Trop Med Hyg 2008; 102 (12): 1263–1268. 5. Figurnov VA, Chertov AD, Romanenko NA, et al. Clonorchiasis in the Upper Amur region: biology, epidemiology, clinical presentation. Med Parazitol (Mosk) 2002; 4: 20–23. 6. Kim TS, Cho SH, Huh S, et al. A nationwide survey on the prevalence of intestinal parasitic infections in the Republic of Korea, 2004. Korean J Parasitol 2009; 47 (1): 37–47. 7. Chok KS, Lo CM. Prevention and management of biliary anastomotic stricture in right-lobe living-donor liver transplantation. J Gastroenterol Hepatol 2014; 29 (10): 1756–1763. 8. Rim HJ. Clonorchiasis: an update. J Helminthol 2005; 79 (3): 269–281.
582
9. Choi MH, Park SK, Li Z, et al. Effect of control strategies on prevalence, incidence and re-infection of clonorchiasis in endemic areas of China. PLoS Negl Trop Dis 2010; 4 (2): e601. 10. Zhu ZJ, Shen ZY, Gao W, et al. Feasibility of using a liver infected with Clonorchis sinensis for liver transplantation: fourteen cases. Liver Transplant 2010; 16 (12): 1440–1442. 11. Rim HJ. [The current pathobiology and chemotherapy of clonorchiasis]. Kisaengchunghak Chapchi (Korean J Parasitol) 1986; 24 (Suppl): 1–141. 12. Chai JY. Praziquantel treatment in trematode and cestode infections: an update. Infect Chemother 2013; 45 (1): 32–43. 13. Ho JK, Lau WY, Liu K, et al. Liver infested with Clonorchis sinensis in orthotopic liver transplantation: a case report. Transplant Proc 1994; 26 (4): 2269–2271. 14. Yeung CK, Ho JK, Lau WY, Lee KH, Li AK. The use of liver grafts infested with Clonorchis sinensis for orthotopic liver transplantation. Postgrad Med J 1996; 72 (849): 427–428. 15. Hwang YJ, Kim YI, Yun YK, Kim JW. Use of liver graft infested with Clonorchis sinensis for living related liver transplantation: a case report. Transplant Proc 2000; 32 (7): 2182–2183. 16. Lee KW, Joh JW, Kim SJ, et al. Living donor liver transplantation using graft infested with Clonorchis sinensis: two cases. Transplant Proc 2003; 35 (1): 66–67. 17. Mahajani RV, Cotler SJ, Uzer MF. Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation. Endoscopy 2000; 32 (12): 943–949. 18. Buxbaum JL, Biggins SW, Bagatelos KC, Ostroff JW. Predictors of endoscopic treatment outcomes in the management of biliary problems after liver transplantation at a high-volume academic center. Gastrointest Endosc 2011; 73 (1): 37–44. 19. Chok KS, Chan SC, Cheung TT, et al. A retrospective study on risk factors associated with failed endoscopic treatment of biliary anastomotic stricture after right-lobe living donor liver transplantation with duct-to-duct anastomosis. Ann Surg 2014; 259 (4): 767–772. 20. Thuluvath PJ, Pfau PR, Kimmey MB, Ginsberg GG. Biliary complications after liver transplantation: the role of endoscopy. Endoscopy 2005; 37 (9): 857–863. 21. Weber A, Prinz C, Gerngross C, et al. Long-term outcome of endoscopic and/or percutaneous transhepatic therapy in patients with biliary stricture after orthotopic liver transplantation. J Gastroenterol 2009; 44 (12): 1195–1202.
Transplant Infectious Disease 2015: 17: 579–582
