title: Surgical outcome and proposed strategy for biliary stricture after living donor liver transplantation: a single center analysis.
abstract: OBJECTIVE
  To clarify the surgical outcome and propose an appropriate strategy for biliary stricture (BS) treatment after living donor liver transplantation (LDLT).
  
  
  METHODS
  Among 53 patients who underwent LDLT at our institute, 45 patients had duct-to-duct anastomosis. Of these, 33 who survived for at least 12 months after LDLT comprised the study group. Clinical parameters, BS treatment outcomes, and predictive factors for long-term patency were investigated.
  
  
  RESULTS
  Eleven patients developed BS. Biliary leakage occurred significantly more frequently, and the number of external biliary tubes was significantly lower than the number of graft bile-duct openings, in the BS group compared with the non-BS group (p=0.001 and 0.004). Multivariate analysis showed that the number of external biliary tubes was the only risk factor. Long-term patency was achieved in two patients in whom stents were retained for more than 20 months, which was significantly longer than in other patients (p=0.01). Identical stent-retention for more than 6 months was a risk factor for cholangitis.
  
  
  CONCLUSIONS
  The number of external biliary tubes should match the number of graft bile-duct openings. When BS occurs, the duration of stent retention should be more than 20 months, and stents should be exchanged at least every 6 months.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. kazutake@yokohama-cu.ac.jp
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takeda
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kumamoto
authors.forename: Kazunori
authors.initials: K
authors.lastname: Nojiri
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Mori
authors.forename: Koichi
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Ryusei
authors.initials: R
authors.lastname: Matsuyama
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology / Q000628:therapy; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation; D002779:Cholestasis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D003251:Constriction, Pathologic; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D007564:Japan; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult