Long-term outcomes of endoscopic management for biliary strictures after living donor liver transplantation with duct-to-duct reconstruction

Transpl Int. 2009 Sep;22(9):914-21. doi: 10.1111/j.1432-2277.2009.00895.x. Epub 2009 May 20.

Abstract

Biliary strictures after living donor liver transplantation (LDLT) with duct-to-duct (D-D) reconstruction are associated with postoperative morbidity and mortality. The aims of this study were to evaluate the long-term outcomes of endoscopic deployment of plastic stents, and to investigate factors associated with the stent deployment failure. Between April 2001 and May 2007, 96 patients received LDLT with D-D reconstruction at Okayama University Hospital. Among them, 41 patients (43%) had anastomotic biliary strictures, and all were referred first for endoscopic retrograde cholangiography (ERC). When deployment was unsuccessful, a percutaneous transhepatic procedure was employed. Successful stent deployment was achieved in 35 out of total 41 patients (85%) by both procedures. Among the 35 patients, 28 had their stents removed as a result of strictures resolution. Eight patients underwent ERC and repeated stent deployment as a result of recurrence of the strictures. Finally, 21 out of 41 (51%) patients with biliary stricture were completely treated by endoscopic therapy during the observation period (median 873 days: range 77-2060). By multivariate analysis, biliary leakage was associated with stent deployment failure. Endoscopic deployment of plastic stents is a first-line therapy for patients with biliary stricture after LDLT.

MeSH terms

  • Adult
  • Aged
  • Anastomosis, Surgical
  • Cholangiopancreatography, Endoscopic Retrograde / methods
  • Cholestasis / surgery
  • Cholestasis / therapy
  • Endoscopy / methods*
  • Female
  • Humans
  • Liver Transplantation / methods*
  • Living Donors
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stents
  • Time Factors
  • Treatment Outcome