Biliary strictures complicating liver transplantation: Incidence, pathogenesis, management, and outcome

J. O. Colonna, A. Shaked, A. S. Gomes, Steven D Colquhoun, O. Jurim, S. V. McDiarmid, J. M. Millis, L. I. Goldstein, R. W. Busuttil, G. Klintmalm, H. A. Pitt, B. W. Shaw, A. H. Aufses, C. Herfarth

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217 Citations (Scopus)

Abstract

Six hundred sixty-six patients received 792 liver transplants between February 1, 1984 and September 30, 1991. Biliary reconstruction was by choledochocholedochostomy (CDCD) with T-tube (n = 509) or Roux-en-Y choledochojejunostomy (CDJ) (n = 283). Twenty-five patients (4%) developed biliary strictures. Anastomotic strictures were more common after CDJ (n = 10, 3.5%) than for CDCD (n = 3, 0.6%). Intrahepatic strictures developed in 12 patients. Six patients had occult hepatic artery thrombosis (HAT). The other six patients received grafts in which cold ischemia time exceeded 12 hours. Anastomotic strictures were successfully managed by percutaneous dilation (PD) in five patients (n = 10), operation in three (n = 6), with re- transplantation required in two patients. Intrahepatic strictures were managed by PD in seven, retransplantation in one, and expectantly in four patients. Of 25 patients, 19 (76%) are alive with good graft function. In three of six deaths, the biliary stricture was a significant factor to the development of sepsis and allograft failure. The authors conclude that (1) anastomotic strictures are rare after LT; (2) the development of biliary strictures may signify occult HAT; (3) PD is effective for most strictures; and (4) extended cold graft ischemia (<12 hours) may be injurious to the biliary epithelium, resulting in intrahepatic stricture formation.

Original languageEnglish (US)
Pages (from-to)344-352
Number of pages9
JournalAnnals of Surgery
Volume216
Issue number3
StatePublished - Jan 1 1992
Externally publishedYes

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Liver Transplantation
Pathologic Constriction
Incidence
Choledochostomy
Transplants
Cold Ischemia
Dilatation
Hepatic Artery
Thrombosis
Allografts
Sepsis
Epithelium
Transplantation
Liver

ASJC Scopus subject areas

  • Surgery

Cite this

Colonna, J. O., Shaked, A., Gomes, A. S., Colquhoun, S. D., Jurim, O., McDiarmid, S. V., ... Herfarth, C. (1992). Biliary strictures complicating liver transplantation: Incidence, pathogenesis, management, and outcome. Annals of Surgery, 216(3), 344-352.

Biliary strictures complicating liver transplantation : Incidence, pathogenesis, management, and outcome. / Colonna, J. O.; Shaked, A.; Gomes, A. S.; Colquhoun, Steven D; Jurim, O.; McDiarmid, S. V.; Millis, J. M.; Goldstein, L. I.; Busuttil, R. W.; Klintmalm, G.; Pitt, H. A.; Shaw, B. W.; Aufses, A. H.; Herfarth, C.

In: Annals of Surgery, Vol. 216, No. 3, 01.01.1992, p. 344-352.

Research output: Contribution to journalArticle

Colonna, JO, Shaked, A, Gomes, AS, Colquhoun, SD, Jurim, O, McDiarmid, SV, Millis, JM, Goldstein, LI, Busuttil, RW, Klintmalm, G, Pitt, HA, Shaw, BW, Aufses, AH & Herfarth, C 1992, 'Biliary strictures complicating liver transplantation: Incidence, pathogenesis, management, and outcome', Annals of Surgery, vol. 216, no. 3, pp. 344-352.
Colonna JO, Shaked A, Gomes AS, Colquhoun SD, Jurim O, McDiarmid SV et al. Biliary strictures complicating liver transplantation: Incidence, pathogenesis, management, and outcome. Annals of Surgery. 1992 Jan 1;216(3):344-352.
Colonna, J. O. ; Shaked, A. ; Gomes, A. S. ; Colquhoun, Steven D ; Jurim, O. ; McDiarmid, S. V. ; Millis, J. M. ; Goldstein, L. I. ; Busuttil, R. W. ; Klintmalm, G. ; Pitt, H. A. ; Shaw, B. W. ; Aufses, A. H. ; Herfarth, C. / Biliary strictures complicating liver transplantation : Incidence, pathogenesis, management, and outcome. In: Annals of Surgery. 1992 ; Vol. 216, No. 3. pp. 344-352.
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