Endoscopic Management of Biliary Complications in Recipients of Living-Donor Liver Transplantation Provides Durable and Efficacious Therapy

Abstract

Background: Biliary complications are a common cause of post-op morbidity in patients undergoing living-donor liver transplantation (LDLT). Their management may include endoscopic, percutaneous, or surgical approaches. Limited data is currently available regarding the efficacy of each of these modalities. We examined our institution's experience in the endoscopic management of biliary complications in LDLT. Methods: We retrospectively reviewed charts of all 50 patients who underwent LDLT at our institution from 9/1/99 to 9/1/04. Information collected on all patients included age, sex, underlying liver disease, anatomy of biliary reconstruction at LDLT, and type of biliary complications treated. Intial and subsequent therapeutic interventions were reviewed, including the use of endoscopic (ERC), percutaneous (PTC) and surgical approaches. For those with endoscopic interventions, we recorded the number of ERCs and the rate of endoscopic success & failure. Endoscopic failure was defined as subsequent need for an alternate treatment modality in a patient whose initial attempts to treat endoscopically were unsuccessful. Results: A total of 50 patients received LDLT at our institution during the specified time period. 18/50 patients (36%) were found to have biliary complications (M=14, F=4). Biliary complications diagnosed included bile leaks in 10/18 (56%), anastomotic strictures in 5/18 (28%), findings consistent with ischemic cholangiopathy in 3/18 (17%), and ampullary stenosis in 1/18 (n=1). One patient had concomitant anastomotic stricture and bile leak. 14/18 patients (78%) had ERC as their initial intervention. Of these patients, only 3/14 (21%) failed endoscopic management: 2 for tight strictures that could not be crossed by a guidewire, and 1 for persistent bile leak; of these, 1/3 underwent PTC, 2/3 underwent reoperation. Mean number of ERCs performed was 3.0 (range 1-8); mean follow-up time was 78.8 weeks. Conclusion: Endoscopic management of biliary complications in recipients of LDLT is efficacious and provides durable therapy, limiting the need for more invasive interventions and reoperation.