Abstract No. 628 Percutaneous transhepatic balloon dilation of biliary anastomotic strictures following living donor liver transplant: review of 9-year experience

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Biliary anastomotic stricture (BAS) is a well-known complication of liver transplant (LT), particularly following living donor liver transplant (LDLT). This study aims to review our experience of percutaneous transhepatic balloon dilation (PTD) of BAS at a large regional LT center. Retrospective review of all adult LDLT patients undergoing PTD of BAS between Jan 2008 and Sept 2017 was performed. Transplant details including type of biliary anastomosis (duct-to-duct (DD) vs hepatojejunostomy (HJ)), procedural details including number of dilation procedures and balloon sizes, were recorded, as well as clinical, biochemical and radiological follow-up. Treatment success was defined as absence of stricture on cholangiogram and successful removal of biliary drain following dilation. Recurrence was defined as symptomatic BAS following initial removal of biliary drain. Treatment success and recurrence rates were compared between HJ and DD groups using Fisher’s exact test. Total 24 patients (18 male, 6 female) with mean age 50.6 years (range, 30-71 years) were included. 17 patients with HJ underwent only PTD, 7 patients with DD anastomosis underwent initial PTD ± subsequent endoscopic balloon dilation. Treatment success was achieved in 21 patients (88%) after mean 3.3 dilation procedures (range, 1-9), and average treatment duration of 171 days (range, 42-647 days). In median 26 months (range, 2-103 months) of posttreatment follow-up, recurrence was seen in 4 patients (17%), with 3 patients requiring further PTD. 3 of 4 cases of recurrence occurred within 6 months of treatment, in patients who underwent a relatively short duration of treatment (≤77 days) and 2 or fewer dilation procedures. Treatment success and recurrence rates were not significantly different between HJ and DD groups (P = 1.00 for both). There were no major complications. PTD is an effective and safe treatment for BAS following LDLT, for both HJ and DD types of biliary anastomosis. Recurrence may be seen in early posttreatment period and may be related to fewer dilations and shorter duration of treatment.