Is There a Role for Prophylactic Internal Biliary Stents With Orthotopic Liver Transplants to Prevent Biliary Complications After Liver Transplantation?

Abstract

Introduction: Biliary complications are a leading source of morbidity following orthrotopic liver transplants (OLT). Limited data exists on the role of prophylactic biliary stenting in OLT. We set out to examine in our transplant population how internal biliary stents placed at the time of surgery affected biliary complications and procedures performed post-liver transplant. Methods: We performed a retrospective review of 273 patients who underwent OLT at our institution from 1/2012 - 4/2015. Two groups were designated based on the placement of a prophylactic internal biliary stent, those with and those without stent placement. Data collected included patient's demographics, hepatitis status, reason for transplantation, imaging, procedure performed, and biliary complications. T-test and logistic regression assessed the association between dependent and independent variables. For continuous data, the results were summarized as mean difference(MD) and standard deviation (SD), and for dichotomous as odds ratio (OR) and 95%confidence intervals (CI). Results: Overall 33 patients received internal biliary stents with liver transplant compared to 240 without. There did not appear to be a statistically significant difference in age or gender (males) between those with and those without a prophylactic stent, 52.7 +/-12.3 vs 56.3 +/-9.3, and 60.6% vs 75.8%, respectively. Although the incidence of anastomotic stricture was lower in the prophylactic stent group 12.1% vs 20.4%, this did not reach statistical significance. There were no differences in other biliary complications or vascular complications between the two groups. In patients requiring at least one post-transplant ERCP, patients without prophylactic stents required a statistically significant higher average number of ERCP's 3.05+/-2.4 vs 2.0 +/-1.0; p=0.046. Conclusion: There appeared to be a lower number of anastomotic strictures in the non-prophylactic stent group, however this did not reach statistical significance. There appeared to be a higher number of ERCP's in those requiring ERCP post-transplant in the non-prophylactic stent group. There may be a role for prophylactic biliary stenting with orthotopic liver transplant, however, this needs to be examined in large randomized controlled trials.Figure 1Figure 2