Long-term Outcome of Endoscopic and Percutaneous Transhepatic Approaches for Biliary Complications in Liver Transplant Recipients

Overview

Journal Transplant Direct

Publisher Wolters Kluwer

Specialty General Surgery

Date 2019 Mar 19

PMID 30882037

Citations 5

Authors

Jesper Ronning

Erik Berglund

Urban Arnelo

Bo-Goran Ericzon

Greg Nowak

Affiliations

Soon will be listed here.

Abstract

Background: Biliary complications occur in 6% to 34% of liver transplant recipients, for which endoscopic retrograde cholangiopancreatography has become widely accepted as the first-line therapy. We evaluated long-term outcome of biliary complications in patients liver transplanted between 2004 and 2014 at Karolinska University Hospital, Stockholm.

Methods: Data were retrospectively collected, radiological images were analyzed for type of biliary complication, and graft and patient survivals were calculated.

Results: In 110 (18.5%) of 596 transplantations, there were a total of 153 cases of biliary complications: 68 (44.4%) anastomotic strictures, 43 (28.1%) nonanastomotic strictures, 24 (15.7%) bile leaks, 11 (7.2%) cases of stone- and/or sludge-related problems, and 7 (4.6%) cases of mixed biliary complications. Treatment success rates for each complication were 90%, 73%, 100%, 82% and 80%, respectively. When the endoscopic approach was unsatisfactory or failed, percutaneous transhepatic cholangiography or a combination of treatments was often successful (in 18 of 24 cases). No procedure-related mortality was observed. Procedure-related complications were reported in 7.7% of endoscopic retrograde cholangiopancreatography and 3.8% of percutaneous transhepatic cholangiography procedures. Patient survival rates, 1, 3, 5, and 10 years posttransplant in patients with biliary complications were 92.7%, 80%, 74.7%, and 54.1%, respectively, compared with 92%, 86.6%, 83.7%, and 72.8% in patients free from biliary complications ( < 0.01). Similarly, long-term graft survival was lower in the group experiencing biliary complications ( < 0.0001).

Conclusions: Endoscopic and percutaneous approaches for treating biliary complications are safe and efficient and should be considered complementing techniques. Despite a high treatment success rate of biliary complications, their occurrence still has a significant negative impact on patient and graft long-term survivals.

Citing Articles

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Biliary complications after liver transplantation: A computed tomography and magnetic resonance imaging pictorial review.

Vernuccio F, Mercante I, Tong X, Crimi F, Cillo U, Quaia E World J Gastroenterol. 2023; 29(21):3257-3268.

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Risk factors and management of biliary stones after living donor liver transplant and its effect on graft outcome.

Dabbous H, Elsayed A, Salah M, Montasser I, Atef M, Elmetenini M Front Med (Lausanne). 2022; 9:927744.

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Gad E, Ayoup E, Aziz A, Ibrahim T, Elhelbawy M, Abd-Elsamee M Ann Med Surg (Lond). 2022; 77:103577.

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Hann A, Seth R, Mergental H, Hartog H, Alzoubi M, Stangou A Transplant Direct. 2020; 7(1):e643.

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References

Schwartz D, Petersen B, Poterucha J, Gostout C . Endoscopic therapy of anastomotic bile duct strictures occurring after liver transplantation. Gastrointest Endosc. 2000; 51(2):169-74. DOI: 10.1016/s0016-5107(00)70413-5. View

Tung B, Kimmey M . Biliary complications of orthotopic liver transplantation. Dig Dis. 2000; 17(3):133-44. DOI: 10.1159/000016918. View

Pfau P, Kochman M, Lewis J, Long W, Lucey M, Olthoff K . Endoscopic management of postoperative biliary complications in orthotopic liver transplantation. Gastrointest Endosc. 2000; 52(1):55-63. DOI: 10.1067/mge.2000.106687. View

Saab S, MARTIN P, Soliman G, Machicado G, Roth B, Kunder G . Endoscopic management of biliary leaks after T-tube removal in liver transplant recipients: nasobiliary drainage versus biliary stenting. Liver Transpl. 2000; 6(5):627-32. DOI: 10.1053/jlts.2000.8200. View

Scatton O, Meunier B, Cherqui D, Boillot O, Sauvanet A, Boudjema K . Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation. Ann Surg. 2001; 233(3):432-7. PMC: 1421262. DOI: 10.1097/00000658-200103000-00019. View

Moser M, Wall W . Management of biliary problems after liver transplantation. Liver Transpl. 2001; 7(11 Suppl 1):S46-52. DOI: 10.1053/jlts.2001.28518. View

Rerknimitr R, Sherman S, Fogel E, Kalayci C, Lumeng L, Chalasani N . Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy. Gastrointest Endosc. 2002; 55(2):224-31. DOI: 10.1067/mge.2002.120813. View

Park J, Kim M, Lee S, Seo D, Lee S, Han J . Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation. Gastrointest Endosc. 2003; 57(1):78-85. DOI: 10.1067/mge.2003.11. View

Guichelaar M, Benson J, Malinchoc M, Krom R, Wiesner R, Charlton M . Risk factors for and clinical course of non-anastomotic biliary strictures after liver transplantation. Am J Transplant. 2003; 3(7):885-90. DOI: 10.1034/j.1600-6143.2003.00165.x. View

10.

Thuluvath P, Atassi T, Lee J . An endoscopic approach to biliary complications following orthotopic liver transplantation. Liver Int. 2003; 23(3):156-62. DOI: 10.1034/j.1600-0676.2003.00823.x. View

11.

Colonna 2nd J, Shaked A, Gomes A, Colquhoun S, Jurim O, McDiarmid S . Biliary strictures complicating liver transplantation. Incidence, pathogenesis, management, and outcome. Ann Surg. 1992; 216(3):344-50; discussion 350-2. PMC: 1242622. DOI: 10.1097/00000658-199209000-00014. View

12.

Morelli J, Mulcahy H, Willner I, Cunningham J, Draganov P . Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement. Gastrointest Endosc. 2003; 58(3):374-9. DOI: 10.1067/s0016-5107(03)00011-7. View

13.

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

14.

Thethy S, Thomson B, Pleass H, Wigmore S, Madhavan K, Akyol M . Management of biliary tract complications after orthotopic liver transplantation. Clin Transplant. 2004; 18(6):647-53. DOI: 10.1111/j.1399-0012.2004.00254.x. View

15.

Zoepf T, Maldonado-Lopez E, Hilgard P, Malago M, Broelsch C, Treichel U . Balloon dilatation vs. balloon dilatation plus bile duct endoprostheses for treatment of anastomotic biliary strictures after liver transplantation. Liver Transpl. 2005; 12(1):88-94. DOI: 10.1002/lt.20548. View

16.

Graziadei I, Schwaighofer H, Koch R, Nachbaur K, Koenigsrainer A, Margreiter R . Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation. Liver Transpl. 2006; 12(5):718-25. DOI: 10.1002/lt.20644. View

17.

Verdonk R, Buis C, Porte R, van der Jagt E, Limburg A, van den Berg A . Anastomotic biliary strictures after liver transplantation: causes and consequences. Liver Transpl. 2006; 12(5):726-35. DOI: 10.1002/lt.20714. View

18.

Buis C, Hoekstra H, Verdonk R, Porte R . Causes and consequences of ischemic-type biliary lesions after liver transplantation. J Hepatobiliary Pancreat Surg. 2006; 13(6):517-24. DOI: 10.1007/s00534-005-1080-2. View

19.

Pasha S, Harrison M, Das A, Nguyen C, Vargas H, Balan V . Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: outcomes after maximal stent therapy. Gastrointest Endosc. 2007; 66(1):44-51. DOI: 10.1016/j.gie.2007.02.017. View

20.

Holt A, Thorburn D, Mirza D, Gunson B, Wong T, Haydon G . A prospective study of standardized nonsurgical therapy in the management of biliary anastomotic strictures complicating liver transplantation. Transplantation. 2007; 84(7):857-63. DOI: 10.1097/01.tp.0000282805.33658.ce. View