Risk Factors and Treatment of Anastomotic Biliary Stricture in Recipients after Living Donor Liver Transplantation
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- Category: Vol. 85, December 2017
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Risk Factors and Treatment of Anastomotic Biliary Stricture in Recipients after Living Donor Liver Transplantation, HOSAM EL-DIN HAMED, MOHAMED MORSY EL-SHOBARY, MOHAMED A. ALI and AHMAD MOHAMMAD A. SULTAN
Abstract
Introduction: Biliary reconstruction and its complications are the “Achilles' heel in liver transplantation. Risk factors for post-transplantation anastomotic biliary strictures are not clearly defined. Identification of risk factors for BS is of paramount importance to avoid evitable factors and reduce the risk with inevitable factors.
Patients and Methods: This is a cohort study of the incidence, risk factors and different treatment modalities of anastomotic biliary stricture after right lobe LDLT. The study population included all recipients who underwent right lobe LDLT in the duration between May 2004 and January 2016 at Mansoura Gastrointestinal Surgical Center, Mansoura University, Egypt.
Results: The incidence of biliary strictures was 19% after living donor liver transplant. Independent risk factors for BS by univariate and multivariate analysis were smaller graft duct diameter in the second biliary anastomosis (p=0.026) and previous history of biliary leakage (p=0.001). Endoscopic retrograde cholangiography was successful in 93% of cases of early BS, in the first 3 months, and 77.8% of late BS.
Conclusion: Biliary complications are the most frequent complications after Living Donor Liver Transplantation (LDLT). Precise preoperative evaluation and meticulous design of the plane of biliary division is of crucial importance to avoid biliary strictures. Further multicenter studies are required to evaluate different treatment modalities for biliary stricture.