Endoscopic treatment of biliary complications after liver transplantation.
OBJECTIVE
To evaluate the efficacy of endoscopic treatment in patients who undergo OLTx or LRLTx and develop biliary complications.


METHODS
This is a prospective, observational study of patients who developed biliary complications, after OLTx and LRLTx, with duct-to-duct anastomosis performed between June 2003 and June 2007. Endoscopic Retrograde Cholangiopancreatography (ERCP) was considered unsuccessful when there was evidence of continuous bile leakage despite endoscopic stent placement, or persistence of stenosis after 1 year, despite multiple dilatation and stent placement. When the ERCP failed, a percutaneous trans-hepatic approach (PTC) or surgery was adopted.


RESULTS
From June 2003 to June 2007, 261 adult patients were transplanted in our institute, 68 from living donors and 193 from cadaveric donors. In the OLTx group the rate of complications was 37.3%, while in the LRLTx group was 64.7%. The rate of ERCP failure was 19.4% in the OLTx group and 38.6% in LRLTx group. In OLTx group, 1 patient was re-transplanted and 8 patients died. In the LRLTx group, 2 patients underwent OLTx and 8 patients died. The follow-up was 23.3 +/- 13.13 mo and 21.02 +/- 14.10 mo, respectively.


CONCLUSIONS
Although ERCP is quite an effective mode of managing post-transplant bile duct complications, a significant number of patients need other types of approach. Further prospective studies are necessary in order to establish whether other endoscopic protocols or new devices, could improve the current results.
Tarantino
Ilaria
I
ISMETT/UPMC, via tricomi 1, Palermo 90100, Italy. itarantino@ismett.edu
Barresi
Luca
L
Petridis
Ioannis
I
Volpes
Riccardo
R
Traina
Mario
M
Gridelli
Bruno
B
D000328:Adult; D001649:Bile Duct Diseases / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000601:surgery*; D011446:Prospective Studies