title: Portal vein stenting as a significant risk factor for biliary stricture in adult living donor liver transplantation.
abstract: BACKGROUND
  Although perioperative portal vein (PV) stent implantation is an effective treatment for steno-occlusive disease in adult living donor liver transplantation (LDLT) recipients, we experienced high incidence of biliary anastomotic strictures (BAS) after PV stenting. In this study, we sought to clarify the relation between BAS and PV stenting and to suggest the possible mechanism of BAS and measures to reduce its incidence.
  
  
  METHODS
  We retrospectively analyzed 44 LDLT recipients who underwent PV stent implantation across the line of PV anastomosis regardless of the location of steno-occlusion (stent group) and their matched controls (non-stented LDLT recipients, n=131).
  
  
  RESULTS
  The incidence of BAS was higher in patients in the stent group than that in the control group (43.2% vs 17.6%, P=0.001). Cumulative 6-month and 1-, 2- and 5-year BAS rates were 31.8%, 34.1%, 41.4% and 43.2%, respectively, in the stent group and 13.0%, 13.8%, 16.1% and 17.8%, respectively, in the control group (P=0.001). Multivariate analysis revealed that PV stenting was an independent risk factor for BAS.
  
  
  CONCLUSIONS
  Although PV stent implantation is a reliable treatment modality for steno-occlusive PV in adult LDLT recipients, innovative methods to prevent the PV stent from crossing the line of PV anastomosis may be necessary to reduce the incidence of postoperative BAS.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul 05505, Korea. mdb1@amc.seoul.kr.
authors.forename: Min-Ho
authors.initials: MH
authors.lastname: Shin
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Gil-Chun
authors.initials: GC
authors.lastname: Park
authors.forename: Young-In
authors.initials: YI
authors.lastname: Yun
authors.forename: Wan-Jun
authors.initials: WJ
authors.lastname: Kim
authors.forename: Woo-Hyoung
authors.initials: WH
authors.lastname: Kang
authors.forename: Seok-Hwan
authors.initials: SH
authors.lastname: Kim
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology*; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010690:Phlebography / Q000379:methods; D011169:Portal Vein / Q000000981:diagnostic imaging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000628:therapy*