Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation

The purpose of this study was to evaluate the results of percutaneous transhepatic management (PTM) of anastomotic biliary strictures (BS). Among 168 liver transplant adult recipients, BS was identified in 30 patients. In 6 patients, narrowing of the anastomosis was found early, and in all cases dis...

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Published in:	Liver transplantation Vol. 9; no. 4; pp. 394 - 400
Main Authors:	Roumilhac, Didier, Poyet, Grégory, Sergent, Géraldine, Declerck, Nicole, Karoui, Mehdi, Mathurin, Phillippe, Ernst, Olivier, Paris, Jean-Claude, Gambiez, Luc, Pruvot, François-René
Format:	Journal Article
Language:	English
Published:	Philadelphia, PA Elsevier Inc 01-04-2003 W.B. Saunders
Subjects:	Acute Disease Adolescent Adult Aged Catheterization - adverse effects Cholestasis - etiology Cholestasis - mortality Cholestasis - therapy Drainage - adverse effects Drainage - methods Female Follow-Up Studies Graft Rejection - surgery Humans Liver Transplantation - adverse effects Male Middle Aged Reoperation Retrospective Studies Stents - adverse effects Treatment Outcome
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Summary:	The purpose of this study was to evaluate the results of percutaneous transhepatic management (PTM) of anastomotic biliary strictures (BS). Among 168 liver transplant adult recipients, BS was identified in 30 patients. In 6 patients, narrowing of the anastomosis was found early, and in all cases disappeared spontaneously with prolonged draining of the bile tube. Within a mean time of 14 months after transplantation, 24 patients had symptomatic BSs, revealed by cholestasis (n = 17) or cholangitis (n = 7). Twenty-two patients underwent PTM as first treatment of BS (balloon dilatation or stent placement). We evaluated the primary and secondary patency rate of PTM. In 1 patient, PTM failed because the stricture could not be passed with the guide wire, necessitating conversion to a Roux-en-Y choledochojejunostomy (CDJ). Fourteen patients were treated by percutaneous balloon dilatation from which 8 patients (57.2%) were recurrence-free with a mean follow-up of 61 months. One patient with a patent biliary anastomosis underwent retransplantation for acute rejection. Twelve patients received metallic expandable stent placement as their primary treatment (n = 7) or after failure of balloon dilatation (n = 5). Recurrent stricture was found in 7 cases (58%) and was treated by PTM (n = 6) or surgery (n = 1). The primary patency rate for PTM was 58.8% at 12 months and the secondary patency rate 88.4%, with a mean follow-up of 47 months (median: 44 months). The mortality rate was 3.5% (one death). PTM with balloon dilatation, stent placement, or both, represent a safe method to treat anastomotic BSs after orthotopic liver transplantation (OLT) resulting in a secondary patency rate of 88% at 5 years. (Liver Transpl 2003;9:394-400.)
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1527-6465 1527-6473
DOI:	10.1053/jlts.2003.50052