title: Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation.
abstract: The purpose of this study was to evaluate the results of percutaneous transhepatic management (PTM) of anastomotic biliary strictures (BS). Among 168 liver transplant adult recipients, BS was identified in 30 patients. In 6 patients, narrowing of the anastomosis was found early, and in all cases disappeared spontaneously with prolonged draining of the bile tube. Within a mean time of 14 months after transplantation, 24 patients had symptomatic BSs, revealed by cholestasis (n = 17) or cholangitis (n = 7). Twenty-two patients underwent PTM as first treatment of BS (balloon dilatation or stent placement). We evaluated the primary and secondary patency rate of PTM. In 1 patient, PTM failed because the stricture could not be passed with the guide wire, necessitating conversion to a Roux-en-Y choledochojejunostomy (CDJ). Fourteen patients were treated by percutaneous balloon dilatation from which 8 patients (57.2%) were recurrence-free with a mean follow-up of 61 months. One patient with a patent biliary anastomosis underwent retransplantation for acute rejection. Twelve patients received metallic expandable stent placement as their primary treatment (n = 7) or after failure of balloon dilatation (n = 5). Recurrent stricture was found in 7 cases (58%) and was treated by PTM (n = 6) or surgery (n = 1). The primary patency rate for PTM was 58.8% at 12 months and the secondary patency rate 88.4%, with a mean follow-up of 47 months (median: 44 months). The mortality rate was 3.5% (one death). PTM with balloon dilatation, stent placement, or both, represent a safe method to treat anastomotic BSs after orthotopic liver transplantation (OLT) resulting in a secondary patency rate of 88% at 5 years.
authors.affiliation: Service de Chirurgie Digestive et Transplantation, Hôpital Huriez, 59037 Lille Cedex, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Roumilhac
authors.forename: Grégory
authors.initials: G
authors.lastname: Poyet
authors.forename: Géraldine
authors.initials: G
authors.lastname: Sergent
authors.forename: Nicole
authors.initials: N
authors.lastname: Declerck
authors.forename: Mehdi
authors.initials: M
authors.lastname: Karoui
authors.forename: Phillippe
authors.initials: P
authors.lastname: Mathurin
authors.forename: Olivier
authors.initials: O
authors.lastname: Ernst
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Paris
authors.forename: Luc
authors.initials: L
authors.lastname: Gambiez
authors.forename: François-René
authors.initials: FR
authors.lastname: Pruvot
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects; D002779:Cholestasis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome