Biliary strictures in liver transplant recipients: Survival of grafts and patients managed with endoscopic retrograde cholangiography

R. S. Rizk, John McVicar, M. J. Emond, C. A. Rohrmann, K. V. Kowdley, J. Perkins, R. L. Carithers, M. B. Kimmey

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Abstract

AIM: Occurrence of biliary strictures in liver transplant recipients can result in decreased patient and graft survival particularly when associated with hepatic artery thrombosis (HAT). The aim of this study was to determine 1]whether liver recipients who develop biliary strictures which are treated endoscopically have excess mortality or graft loss 2] how patients with donor hepatic duct (DHD) strictures or choledochochotedochostomy (CDC) strictures differ in their response to endoscopic therapy. METHODS: Of 251 consecutive liver transplant recipients, 22 patients with biliary strictures whose graft survived at least 90 days were categorized by a blinded radiologist into: Group 1, DHD strictures (n=12) and Group 2, CDC strictures(n=10). Strictures were dilated with 4 - 8 mm balloons followed by placement of 1 or 2 stents (10 - 11.5 Fr.) positioned across the stricture(s) for at least 12 weeks. Successful endoscopic therapy was defined as a patient not requiring repeat stenting or dilation for 1 year. RESULTS: Using Cox proportional hazards analysis, occurrence of strictures did not significantly alter patient or graft survival in the 22 stricture patients compared with the 175 non-stricture patients (relative risk of death and graft survival 1.8 and 1.3, respectively). DHD strictures required a significantly longer period of therapy than CDC strictures to be successfully treated, median days 185 vs. 67, p=.02. At 22 months after the first ERCP, only 73% of DHD group were stent free compared with 90% of the patients in the CDC group (p=.02). The DHD group had significantly (p<05) more HAT (58.3% vs. 10%), cholangitis(58.3% vs. 30%), choledocholithiasis (91% vs. 10%), sphincterotomies (11 vs. 4) and endoscopies (4.5 vs. 3) No patient undergoing endoscopic treatment required retransplantation or biliary reconstruction during a median follow-up of 35.7 month. Procedure related deaths, severe pancreatitis or infection did not occur in any patient. CONCLUSIONS: Liver transplant recipients with biliary strictures can be effectively treated endoscopically. DHD strictures require more endoscopic interventions and a longer period of therapy than CDC strictures but can ultimately be successfully treated. DHD strictures associated with HAT can be treated endoscopically.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume45
Issue number4
StatePublished - 1997
Externally publishedYes

ASJC Scopus subject areas

  • Gastroenterology

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    Rizk, R. S., McVicar, J., Emond, M. J., Rohrmann, C. A., Kowdley, K. V., Perkins, J., Carithers, R. L., & Kimmey, M. B. (1997). Biliary strictures in liver transplant recipients: Survival of grafts and patients managed with endoscopic retrograde cholangiography. Gastrointestinal Endoscopy, 45(4).