Response to endoscopic therapy for biliary anastomotic strictures in deceased versus living donor liver transplantation

BACKGROUND:Endoscopic therapy has been successful in the management of biliary complications after both deceased donor liver transplantation(DDLT) and living donor liver transplantation(LDLT).LDLT is thought to be associated with higher rates of biliary complications,but there are few studies compar...

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Published in:	Hepatobiliary & pancreatic diseases international Vol. 12; no. 5; pp. 488 - 493
Main Authors:	Chan, Calvin HY, Donnellan, Fergal, Byrne, Michael F, Coss, Alan, Haque, Mazhar, Wiesenger, Holly, Scudamore, Charles H, Steinbrecher, Urs P, Weiss, Alan A, Yoshida, Eric M
Format:	Journal Article
Language:	English
Published:	Singapore Elsevier B.V 01-10-2013
Subjects:	Adult Anastomosis, Surgical biliary biliary tract surgical procedures biliary tree cholangiopancreatography Cholangiopancreatography, Endoscopic Retrograde - adverse effects Cholestasis - diagnosis Cholestasis - etiology Cholestasis - surgery Constriction, Pathologic Endocrinology & Metabolism endoscopic endoscopic retrograde cholangiopancreatography failure Female Gastroenterology and Hepatology Humans liver liver failure liver transplantation Liver Transplantation - adverse effects Living Donors Male Middle Aged procedures Reoperation retrograde Retrospective Studies surgical Time Factors tract transplantation Treatment Outcome tree endoscopic retrograde cholangiopancreatography biliary tree liver failure liver transplantation biliary tract surgical procedures
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Summary:	BACKGROUND:Endoscopic therapy has been successful in the management of biliary complications after both deceased donor liver transplantation(DDLT) and living donor liver transplantation(LDLT).LDLT is thought to be associated with higher rates of biliary complications,but there are few studies comparing the success of endoscopic management of anastomotic strictures between the two groups.This study aims to compare our experience in the endoscopic management of anastomotic strictures in DDLT versus LDLT.METHODS:This is a retrospective database review of all liver transplant patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) after liver transplantation.The frequency of anastomotic stricture and the time to develop and to resolve anastomotic stricture were compared between DDLT and LDLT.The response of anastomotic stricture to endoscopic therapy was also analyzed.RESULTS:A total of 362 patients underwent liver transplantation between 2003 and 2011,with 125 requiring ERCP to manage biliary complications.Thirty-three(9.9%) cases of DDLT and 8(27.6%) of LDLT(P=0.01) were found to have anastomotic stricture.When comparing DDLT and LDLT,there was no difference in the mean time to the development of anastomotic strictures(98±17 vs 172±65 days,P=0.11),likelihood of response to ERCP [22(66.7%) vs 6(75.0%),P=0.69],mean time to the resolution of anastomotic strictures(268±77 vs 125±37 days,P=0.34),and the number of ERCPs required to achieve resolution(3.9±0.4 vs 4.7±0.9,P=0.38).CONCLUSIONS:Endoscopic therapy is effective in the majority of biliary complications relating to liver transplantation.Anastomotic strictures occur more frequently in LDLT compared with DDLT,with equivalent endoscopic treatment response and outcomes for both groups.
Bibliography:	Calvin HY Chan;Fergal Donnellan;Michael F Byrne;Alan Coss;Mazhar Haque;Holly Wiesenger;Charles H Scudamore;Urs P Steinbrecher;Alan A Weiss;Eric M Yoshida;Division of Gastroenterology General Hospital,University of British Columbia;Department of Surgery Vancouver General Hospital,University of British Columbia 33-1391/R ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1499-3872
DOI:	10.1016/S1499-3872(13)60077-6