{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T20:25:04Z","timestamp":1778099104276,"version":"3.51.4"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2013,4,21]],"date-time":"2013-04-21T00:00:00Z","timestamp":1366502400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Biliary cast syndrome (<jats:styled-content style=\"fixed-case\">BCS<\/jats:styled-content>) is characterized by the retention of lithogenic material leading to obstructive cholangitis and subsequent liver damage. <jats:styled-content style=\"fixed-case\">BCS<\/jats:styled-content> after orthotopic liver transplantation (<jats:styled-content style=\"fixed-case\">OLT<\/jats:styled-content>) can lead to retransplantation or death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>Evaluation of aetiology, risk factors and outcome of <jats:styled-content style=\"fixed-case\">BCS<\/jats:styled-content> after <jats:styled-content style=\"fixed-case\">OLT<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a retrospective single centre analysis between 2002 and 2011, all <jats:styled-content style=\"fixed-case\">OLT<\/jats:styled-content> patients with <jats:styled-content style=\"fixed-case\">BCS<\/jats:styled-content> diagnosed by endoscopic retrograde cholangiography were identified and compared with a matched control group at a 2:1 ratio.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty patients with <jats:styled-content style=\"fixed-case\">BCS<\/jats:styled-content> after <jats:styled-content style=\"fixed-case\">OLT<\/jats:styled-content> were identified (30\/887, 3.4%). Seventy per cent of those patients (21\/30) underwent transplantation in the Model for Endstage Liver Disease (<jats:styled-content style=\"fixed-case\">MELD<\/jats:styled-content>) score era. Median time to diagnosis after <jats:styled-content style=\"fixed-case\">OLT<\/jats:styled-content> was 255\u00a0days (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content> 107\u2013621). Intensive care unit treatment after <jats:styled-content style=\"fixed-case\">OLT<\/jats:styled-content> was significantly longer in <jats:styled-content style=\"fixed-case\">BCS<\/jats:styled-content> patients [16\u00a0days (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content> 8\u201342) vs. 9 (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content> 7\u201317) days; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.039]. In a multivariate analysis, hepatic artery stenosis (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.04), biliary strictures (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.032) and need for renal replacement therapy (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.002) were significantly associated with <jats:styled-content style=\"fixed-case\">BCS<\/jats:styled-content>. Immunosuppressant regimen, operation time, cold or warm ischaemia time, graft size, acute cellular rejection and cytomegalovirus infections were not significantly different between both groups. Retransplantation rate and 12\u2010month mortality were significantly higher with <jats:styled-content style=\"fixed-case\">BCS<\/jats:styled-content> (9\/30, 30% vs. 4\/60, 7%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.003).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">BCS<\/jats:styled-content> is a rare, but severe complication after <jats:styled-content style=\"fixed-case\">OLT<\/jats:styled-content>. Patients with hepatic artery stenosis, biliary strictures or renal replacement therapy have the highest risk to develop <jats:styled-content style=\"fixed-case\">BCS<\/jats:styled-content> and should therefore be monitored carefully.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.12181","type":"journal-article","created":{"date-parts":[[2013,4,1]],"date-time":"2013-04-01T16:21:05Z","timestamp":1364833265000},"page":"1287-1292","source":"Crossref","is-referenced-by-count":25,"title":["Biliary cast syndrome post\u2013liver transplantation: risk factors and outcome"],"prefix":"10.1111","volume":"33","author":[{"given":"Torsten","family":"Voigtl\u00e4nder","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed A.","family":"Negm","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian P.","family":"Strassburg","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany"},{"name":"Department of Internal Medicine I University of Bonn University Hospital Bonn Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Lehner","sequence":"additional","affiliation":[{"name":"Department of Visceral and Transplantation Surgery Hannover Medical School Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael P.","family":"Manns","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany"},{"name":"Integrated Research and Treatment Center \u2013 Transplantation (IFB\u2010Tx) Hannover Medical School Hannover 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