Biliary strictures after living-donor liver transplantation with hepaticojejunostomy: risk factors, treatment and long-term follow up

Abstract

Background: Biliary strictures (BS) can continue to occur for a long time after liver transplantation. This study was performed to evaluate variables associated with BS, treatment and the long-term impact of BS after living-donor liver transplantation (LDLT). Patients and methods: We reviewed the records of 80 pediatric and 75 adult patients, who underwent LDLT with hepaticojejunostomy. The patients who died within 1 year after LDLT were excluded. Median follow-up period was 128 months [12–316 months]. Result: BS occurred in 16 (20%) pediatric and 8 (20%) adult patients. The cumulative incidence of BS at 5 and 10 years was 14.5% and 17.3% in pediatric patients, 15.8% and 21.0% in adult patients, respectively. Multivariate analysis revealed that multiple bile ducts (OR, 8.846; p=0.02) and previous biliary leak (OR, 18.116; p=0.007) were significant risk factors of BS in pediatric patients. In adult patients, there was no significant risk factor. Percutaneous transhepatic biliary interventions were performed in 10 pediatric and 2 adult patients. Endoscopic therapy with double-balloon endoscopy were performed in 5 adult patients, and surgical intervention were performed in 8 pediatric patients. Pediatric patients with BS had inferior survival to those without (87.1% vs. 98.2% at 10 years. p=0.004). Whereas, adult patients with BS did not have significant inferior survival to those without (62.5% vs. 86.5% at 10 years. p=0.4). Conclusion: Multiple bile ducts and biliary leak are significant risk factors of BS in pediatric LDLT. BS continue to have a clinically relevant impact on long-term survival especially in pediatric patients.