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Anastomotic Biliary Stricture Following Liver Transplantation and Management Analysis: 15 Years of Experience at a High-Volume Transplant Center Publisher Pubmed



Eslami O1, 2 ; Moazzami B3 ; Zabala ZE3 ; Roushan N1 ; Dashti H1 ; Fakhar N1 ; Saberi H4 ; Jafarian A1 ; Toosi MN1, 5
Authors
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Authors Affiliations
  1. 1. Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
  3. 3. Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, United States
  4. 4. Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Liver Transplantation, Imam Khomeini Hospital, Tehran University of Medical Science, Keshavarz Blvd, Tehran, Iran

Source: Indian Journal of Gastroenterology Published:2022


Abstract

Introduction: The occurrence of anastomotic biliary stricture (BS) remains an essential issue following liver transplantation (LT). The present study aimed to compare our findings regarding the incidence of anastomotic BS to what is known. Methods: The present study is a single-center, retrospective cohort study of a total number of 717 consecutive patients (426 men and 291 women) who had undergone LT from January 2001 to March 2016. Multivariable Cox regression analysis was conducted to evaluate the risk factors associated with anastomotic BS development. Results: Post-transplant anastomotic BS developed in 70 patients (9.8%). In the Cox multivariate analysis (a stepwise forward conditional method), factors including biliary leak (hazard ratio [HR]: 6.61, 95% confidence interval [CI]: 3.08–17.58, p < 0.001), hepatic artery thrombosis (HR: 2.29, 95% CI: 1.03–5.88; p = 0.003), and acute rejection (HR: 2.18, 95% CI: 1.16–3.37; p = 0.006) were identified as independent risk factors for the development of anastomotic BS. Surgery in 6 cases (66.7%), followed by endoscopic retrograde cholangiopancreatography (ECRP) with a metal stent in 18 cases (62.1%), percutaneous transhepatic biliary drainage in 9 (20.9%), and ERCP with a single plastic stent in 8 (18.2%), had the highest effectiveness rates in the management of BS, respectively. Conclusions: Risk factors including biliary leak, hepatic artery thrombosis, and acute rejection were independently associated with an anastomotic BS. ERCP with a metal stent may be considered as an effective treatment procedure with a relatively low complication rate in the management of benign post-LT anastomotic BS. © 2022, Indian Society of Gastroenterology.
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