title: Predictors of the feasibility of primary endoscopic management of biliary strictures after adult living donor liver transplantation.
abstract: Biliary strictures are a major cause of morbidity and mortality for liver transplant recipients. The endoscopic management of biliary strictures is not well established after living donor liver transplantation (LDLT) in comparison with deceased donor liver transplantation. The aims of this study were to assess the initial success rate of primary endoscopic treatment of biliary strictures after LDLT and to identify predictors of the feasibility of endoscopic management. One hundred thirty-seven adult patients who underwent LDLT and were confirmed to have biliary strictures by endoscopic retrograde cholangiopancreatography (ERCP) were enrolled. The biliary strictures were primarily managed endoscopically with internal drainage or nasobiliary catheterization. The initial success rate for the primary endoscopic management of biliary strictures after LDLT was 46.7% (64 of 137 patients), and the feasibility of endoscopic management was associated with the stricture-to-ERCP interval (the interval between the development of the total bilirubin, aspartate aminotransferase, or alanine aminotransferase level to >2 times the upper limit of normal and the performance of ERCP) as well as cholangiographic findings (eg, the stricture morphology and the tip shape of the distal duct). In conclusion, when biliary strictures are noticed after LDLT, prompt endoscopic interventions may improve the initial success rate of primary endoscopic management. In addition, the feasibility of primary endoscopic management can be predicted by the cholangiographic findings, which may help with the choice of the therapeutic modality.
authors: Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea.
authors: Yun Young
authors: YY
authors: Lee
authors: Geum-Youn
authors: GY
authors: Gwak
authors: Kwang Hyuck
authors: KH
authors: Lee
authors: Jong Kyun
authors: JK
authors: Lee
authors: Kyu Taek
authors: KT
authors: Lee
authors: Choon Hyuck David
authors: CH
authors: Kwon
authors: Jae-Won
authors: JW
authors: Joh
authors: Suk-Koo
authors: SK
authors: Lee
mesh_terms: D000328:Adult; D002404:Catheterization; D057785:Catheters; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D003251:Constriction, Pathologic; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome