3:45 PM Abstract No. 104 Percutaneous management of biliary strictures following orthotopic liver transplantation: long-term outcomes analysis

Abstract

To retrospectively evaluate long-term outcomes following percutaneous biliary drainage (PBD) for treatment of posttransplant biliary stricture. Patients with posttransplant biliary stricture managed with an institutional protocol of PBD placement, serial drain upsize and cholangioplasty were reviewed. Biliary drains were removed if cholangiogram demonstrated unobstructed biliary flow, and liver function tests remained stable after placement of an end-hole 5Fr catheter. Stricture patency rates following drain removal were estimated using the Kaplan-Meier method and compared between groups using the Log-rank test. Cox regression analysis was performed to identify predictors of recurrent biliary stricture. 25 patients (15 males, 10 females) were identified for analysis. Patients with primary sclerosing cholangitis comprised the largest subgroup (n = 13, 52%). 40% (n = 10) had anastomotic strictures, 44% (n = 11) had non-anastomotic strictures, and 16% (n = 4) had multifocal strictures. 68% (n = 17) had a single drain, 28% (n = 7) had two drains, and 4% (n = 1) had three or more drains. 44% (n = 11) underwent failed endoscopic treatment prior to PBD. The median duration of biliary drainage was 302 days. 72% patency rate was observed following drain removal at up to 148 months. 8% of patients (n = 2) failed PBD and underwent surgical revision (n = 1) or re-transplant (n = 1). Following drain removal, 20% (n = 5) developed repeat biliary stricture necessitating re-intervention (repeat PBD, n = 4 and repeat transplant, n = 1). Significantly decreased stricture patency was observed for patients requiring multiple vs. single drain (P = 0.034). In univariate analysis, larger final drain size (HR: 0.21, P = 0.027) was associated with lower hazards of drain failure while increased drain dwell time was associated with a higher hazard of drain failure (HR: 1.09, P = 0.020). Percutaneous management of posttransplant biliary stricture provided long-term stricture patency in 72% of patients. Repeat transplant or surgery was needed in 12%. Larger final drain size and increased drain dwell time are associated with higher and lower patency rates, respectively.