title: Endoscopic Management of Biliary Leaks and Strictures After Living Donor Liver Transplantation: Optimizing Techniques for Successful Management.
abstract: Biliary complications (BCs) occur in up to 40% of living donor liver transplant (LDLT) recipients. The aim of this study was to evaluate the efficacy of endoscopic therapy in the management of LDLT-related BCs.
  
  
  
  A retrospective study of 100 LDLT recipients at a single transplant center over a 9-year period was conducted. BC was defined as a biliary leak and/or a stricture. Patient records were used to identify time to diagnosis, type of intervention, and time to resolution.
  
  
  
  BCs occurred in 46 (46%) patients; median follow-up was 4.6 years (range 5 days-9.3 years); and median time to diagnosis was 37.5 days (range 1 day-3.5 years). BCs were classified as a leak in 6 (6%), stricture in 22 (22%), and a leak + stricture in 18 (18%). ERCP was the initial treatment modality in 43/46 (93%) patients and was completed in 42/43 (98%). Three (6.5%) patients with a leak underwent surgery as the primary treatment approach. The median time to resolution of BCs was 91.5 days (range 21-367). Thirteen patients had a recurrence which was managed with endoscopic therapy alone.
  
  
  
  Endoscopic therapy was successful in almost all patients (98%) and ERCP alone resulted in successful treatment in a higher proportion of patients (93%) than traditionally reported. Advanced endoscopic techniques obviate the need for PTC and/or surgery and allow successful management in almost all LDLT recipients presenting with BC and in patients with recurrence of strictures.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 406 Harvard St. SE, MMC 36, Minneapolis, MN, 55455, USA.
authors.forename: Saleh
authors.initials: S
authors.lastname: Elwir
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 406 Harvard St. SE, MMC 36, Minneapolis, MN, 55455, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Thompson
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 406 Harvard St. SE, MMC 36, Minneapolis, MN, 55455, USA.
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Amateau
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 406 Harvard St. SE, MMC 36, Minneapolis, MN, 55455, USA.
authors.forename: Guru
authors.initials: G
authors.lastname: Trikudanathan
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 406 Harvard St. SE, MMC 36, Minneapolis, MN, 55455, USA.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Attam
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 406 Harvard St. SE, MMC 36, Minneapolis, MN, 55455, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hassan
authors.affiliation: Division of Solid Organ Transplant, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Raja
authors.initials: R
authors.lastname: Kandaswamy
authors.affiliation: Division of Solid Organ Transplant, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Pruett
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 406 Harvard St. SE, MMC 36, Minneapolis, MN, 55455, USA.|Division of Solid Organ Transplant, University of Minnesota, Minneapolis, MN, USA.
authors.forename: John
authors.initials: J
authors.lastname: Lake
authors.affiliation: Division of Solid Organ Transplant, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
authors.affiliation: Division of Solid Organ Transplant, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Freeman
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 406 Harvard St. SE, MMC 36, Minneapolis, MN, 55455, USA. arain001@umn.edu.
authors.forename: Mustafa A
authors.initials: MA
authors.lastname: Arain
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000000981:diagnostic imaging / Q000601:surgery*; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D049448:Cholangiopancreatography, Magnetic Resonance; D003251:Constriction, Pathologic / Q000601:surgery; D016208:Databases, Factual; D016145:Endoscopy, Digestive System; D005260:Female; D006498:Hepatectomy; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Biliary complications; Biliary strictures; ERCP; Leaks; Living donor liver transplantation