title: Internal biliary stenting during orthotopic liver transplantation: anastomotic complications, post-transplant biliary interventions, and survival.
abstract: BACKGROUND
  Biliary complications are a leading source of surgical morbidity following orthotopic liver transplantation (OLT).
  
  
  METHODS
  We examined how prophylactic internal biliary stent placement during OLT affected post-transplant morbidity and mortality in a single-center retrospective cohort study of 513 recipients (2006-2012). Recipient and donor covariates were collected. Biliary complications included major and minor anastomotic leaks, strictures, or stenoses. Multivariate regression models were created to estimate how operative biliary stents affected outcomes.
  
  
  RESULTS
  About 87.3% (n = 448) of recipients had a duct-to-duct biliary anastomosis, and 43.1% (n = 221) had biliary stents placed. The biliary complication rate was <15% at five yr, and 44.8% (n = 230) overall. Stenting was not protective from anastomotic biliary complications (p = 0.06). Stenting was associated with a 74% higher adjusted risk of needing multiple endoscopic retrograde cholangiographies (ERCs; odds ratio [OR] 1.74, p = 0.011), and trended toward a lower adjusted risk for repetitive percutaneous transhepatic cholangiography (PTCs; OR 0.56, p = 0.063). Stenting had no effect on the cumulative freedom from biliary complications (p = 0.94). Biliary complications were associated with mortality (HR 1.86, p = 0.014) and was unaffected by stenting (aHR = 0.72, p = 0.246).
  
  
  CONCLUSIONS
  Biliary stenting during OLT does not deter biliary complications and is associated with higher risk of multiple invasive biliary interventions, particularly ERCs. Surgeons should evaluate the utility of biliary stents at OLT within this context.
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA; Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Charleston, SC, USA.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Mathur
authors.forename: Satish N
authors.initials: SN
authors.lastname: Nadig
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kingman
authors.forename: Dustin
authors.initials: D
authors.lastname: Lee
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kinkade
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sonnenday
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Welling
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001660:Biliary Tract Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D001662:Biliary Tract Surgical Procedures / Q000401:mortality*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000401:mortality; D003251:Constriction, Pathologic / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate
keywords: bile duct; biliary complications; liver transplant; stenting