Long Term Outcome of Endoscopic Management of Biliary Strictures Following Liver Transplantation

Abstract

Background: Biliary strictures are a common complication following orthotopic liver transplantation (OLT). ERCP with biliary stenting has been used successfully to treat these strictures but the long-term outcome is unknown. Methods: Twenty-two of 251 patients who underwent OLT from 1/90 and 11/95 developed biliary strictures. Medical records through 12/02 of these 22 patients were reviewed to determine the long-term success of endoscopic therapy. We compared the total number of episodes of jaundice or cholangitis, ERCPs, percutaneous cholangiography, graft and patient survival, and number of patients who remained stent-free at 5 years post OLT in those with only anastomotic strictures to those with donor hepatic duct (DHD) strictures. Results: Twelve of 22 patients had DHD strictures and 10 patients had anastomotic strictures. Patients with DHD strictures required significantly more ERCPs until stricture resolution. The average time to endoscopically documented resolution of strictures was significantly longer in the DHD stricture group than in the anastomotic stricture group (23.7 months versus 3.2 months, p = 0.01). There was no difference in the number of episodes of cholangitis, jaundice, and need for percutaneous cholangiography between the two groups. Five years following liver transplantation, 9 of 12 patients with DHD strictures were stent-free and 9 of 10 patients with anastomotic strictures were stent-free. Overall patient and graft survival did not differ between the two groups. None of the patients died from endoscopic procedure related mortality, or biliary sepsis. Conclusion: Endoscopic management of anastomotic and donor hepatic duct strictures following OLT is safe, effective, and durable. Endoscopic management of DHD strictures is not associated with reduced patient or graft survival when compared to anastomotic strictures but more intensive management is required.