Endoscopic management of biliary strictures in liver transplant recipients: effect on patient and graft survival.
BACKGROUND
Biliary strictures in liver transplant recipients cause significant morbidity and can lead to reduced patient and graft survival.


METHODS
Of 251 liver transplant recipients, 22 patients with biliary strictures were categorized into two groups: donor hepatic duct (n = 12) or anastomotic (n = 10). Strictures were dilated and stented. Endoscopic therapy was considered successful if a patient did not require repeat stenting or dilation for 1 year.


RESULTS
Patient and graft survival did not differ significantly in the 22 patients compared with patients without strictures (relative risk of death and graft survival 1.8 and 1.3). Donor hepatic duct strictures required significantly longer therapy than anastomotic strictures (median days 185 versus 67, p = 0.02). Twenty-two months after the first endoscopic treatment, 73% of the donor hepatic duct stricture group were stent free compared with 90% of the anastomotic group (p = 0.02). The former group had significantly more (p < 0.05) hepatic artery thrombosis (58.3% versus 10%), cholangitis (58.3% versus 30%), choledocholithiasis (91% versus 10%), and endoscopic interventions. No patient undergoing endoscopic treatment required retransplantation or biliary reconstruction during a median follow-up of 35.7 months.


CONCLUSIONS
Endoscopic therapy of biliary strictures after liver transplantation is effective and is not accompanied by reduced patient or graft survival.
Rizk
R S
RS
Department of Medicine, University of Washington at Seattle, 98195, USA.
McVicar
J P
JP
Emond
M J
MJ
Rohrmann
C A
CA
Kowdley
K V
KV
Perkins
J
J
Carithers
R L
RL
Kimmey
M B
MB
D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000628:therapy; D001651:Cholestasis, Extrahepatic / Q000628:therapy*; D005260:Female; D042882:Gallstones / Q000628:therapy; D006085:Graft Survival; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000628:therapy; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*