Predictors of Post-Liver Transplantation Biliary Strictures and Outcomes of Endoscopic Interventions Publisher



Taher M ; Peysepar R ; Avanaki F ; Sheybani A ; Toosi MN ; Jafarian A
Source: Egyptian Liver Journal Published:2025

Abstract

Background: Biliary strictures are the most common complication after liver transplantations, and many preoperative and intraoperative factors have been considered to contribute to biliary strictures. The biliary complications should be managed since these might be related to severe adverse events such as graft failure and overall higher graft failure. Endoscopic Retrograde Cholangiopancreatography (ERCP) provides a less invasive option for biliary stricture with favorable long-term results and documented safety and efficacy. Objective: This study aims to determine the factors associated with post-liver transplantation biliary stricture and analyze the outcomes of endoscopic interventions performed at the Imam Khomeini Hospital Complex from March 2017 to March 2021. Methods: This retrospective cohort study was conducted between March 2017 and March 2021 in a Hospital Complex affiliated with Tehran University of Medical Sciences. Patients undergoing liver transplantation were included in this study. Patient data, including demographics, type of intervention, intervention-related complications, laboratory findings, liver function tests, and outcomes, were extracted from the patient’s medical records using a data collection form. Statistical data were analyzed using SPSS software. Results: In this study, 545 LT cases were evaluated, of which 57 (10.5%) patients had biliary stricture. The mean age of the subjects was 42.24 ± 16.48 years, and comprised 237 (43.5%) females and 308 (56.5%) males. Graft rejection was observed in 80 (14.9%) cases and 131 (24.0%) cases demised during the study. Hepatic arterial thrombosis and cytomegalovirus (CMV) infection were significantly more common in patients with biliary stricture. ERCP yielded a resolution rate of 75% and an effectiveness rate of 31.8% for the management of biliary stricture, which were not statistically significant compared to surgical and percutaneous transhepatic cholangiographic interventions. Conclusion: CMV infection and hepatic artery thrombosis were significantly linked with biliary strictures following liver transplantation. Moreover, ERCP remains an effective and safe first-line therapeutic approach in managing biliary strictures. © 2025 Elsevier B.V., All rights reserved.