Endoscopic treatment of anastomotic biliary strictures after living donor liver transplantation: outcomes after maximal stent therapy.

摘要: Background Living-donor liver transplantation (LDLT) has emerged as a viable strategy in an era of organ shortage. However, biliary strictures are common complication LDLT, and these frequently require surgical revision after unsuccessful endoscopic therapy. The optimal treatment for anastomotic (ABSs) LDLT is undefined. Objective To determine the outcome aggressive approach to ABSs that uses dilation followed by maximal stent placement. Design A retrospective study. Setting tertiary-care academic medical center. Patients Forty-one patients with diagnosis ABS. Interventions Endoscopic retrograde cholangiography balloon stenting. Main Outcome Measurements Stricture resolution, stricture recurrence, rates. Results Of 110 LDLTs completed, developed 41 (37.3%), which included 38 duct-to-duct anastomosis. median (interquartile range [IQR]) follow-up time 74.2 (2.5-120.8) months. Among them, 23 (60.5%) were male, 20 (52.6%) had bile leakage associated ABSs. (IQR) development ABS was 2.1 (1.2-4.1) attempted initial therapy all patients: 32 managed entirely therapy, 6 required percutaneous transhepatic (PTC) cross stricture, performed thereafter. 4.0 (3.0-5.3) interventions 7.0 (4.0-10.3) stents resolve stricture. from first intervention resolution 5.3 (range 3.8-8.9) Biochemical markers including aspartate transaminase (76 vs 39 U/L, P = .001), alanine (127.5 45.5 .017) significantly improved intervention. Recurrent observed 8 (21%) patients. All recurrences successfully re-treated endoscopically. have been without or retransplantation, resulting 100% success intention-to-treat analysis. Limitations Retrospective study, small sample size. Conclusions In this series, endoscopy-based placement allows need retransplantation.