title: Predictors of endoscopic treatment outcome in the management of biliary complications after orthotopic liver transplantation.
abstract: OBJECTIVE
  The most common complications after liver transplantation nowadays affect the biliary tract.We carried out a retrospective study to identify predictors of endoscopic treatment outcome in the management of post-transplantation biliary complications.
  
  
  METHODS
  Data from all patients with post-transplantation biliary complications subjected to endoscopic treatment at the University of Udine between 2000 and 2012 were extracted. To identify predictors of endoscopic treatment outcome, a logistic regression analysis was carried out. Cox modeling was used to identify factors associated with mortality.
  
  
  RESULTS
  We identified 142 patients who developed biliary complications: 83 of these patients had a successful endoscopic therapy, whereas 45 had a failure. Fourteen patients, who developed nonanastomotic biliary stricture, were excluded from the analysis. Patients with biliary complications who had pretransplant Model for End-Stage Liver Disease score more than 10 [odds ratio (OR) 3.88; 95% confidence interval (CI) 1.16-12.95; P = 0.03] and stent retention time more than 12 months (OR 6.45; 95% CI 2.14-19.42; P < 0.01) were less likely to respond to endoscopic therapy. In contrast, both dilatation and stenting procedures (OR 0.10; 95% CI 0.03-0.30; P < 0.01) and 10 Fr diameter stent placement (OR 0.21; 95% CI 0.07-0.70; P = 0.01) predicted favorable endoscopic treatment outcome. Time to the occurrence of biliary complications of more than 3 months [hazard ratio (HR) 0.24; 95% CI 0.10-0.56] and placement of five or more stents (HR 0.31; 95% CI 0.12-0.79) were found to be protective against mortality, whereas hepatic artery thrombosis was a significant risk factor for mortality (HR 13.88; 95% CI 4.08-47.25).
  
  
  CONCLUSIONS
  We found endoscopic treatment to be less effective in patients with pretransplant Model for End-Stage Liver Disease score more than 10 and stent retention time more than 12, whereas dilatation and stenting procedure and 10 Fr diameter stent placement predicted a favorable outcome.
authors.affiliation: aDepartment of Gastroenterology and Digestive Endoscopy, Academic Center 'Santa Maria della Misericordia' bLiver Transplantation Unit, Department of Surgery cMedical Liver Transplant Section, Department of Internal Medicine, University of Udine, Udine dFaculty of Medicine, University of Belgrade eUniversity Clinical-Hospital Center 'Dr Dragisa Misovic-Dedinje', Belgrade, Serbia.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Faleschini
authors.forename: Salvatore F
authors.initials: SF
authors.lastname: Vadalà di Prampero
authors.forename: Milutin
authors.initials: M
authors.lastname: Bulajic
authors.forename: Umberto
authors.initials: U
authors.lastname: Baccarani
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Toniutto
authors.forename: Nikola
authors.initials: N
authors.lastname: Panic
authors.forename: Loris M
authors.initials: LM
authors.lastname: Zoratti
authors.forename: Marco
authors.initials: M
authors.lastname: Marino
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zilli
mesh_terms: D001660:Biliary Tract Diseases / Q000209:etiology* / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome