Predictors of endoscopic treatment outcome in the management of biliary complications after orthotopic liver transplantation.

Abstract

The most common complications after liver transplantation nowadays affect the biliary tract.We carried out a retrospective study to identify predictors of endoscopic treatment outcome in the management of post-transplantation biliary complications. Data from all patients with post-transplantation biliary complications subjected to endoscopic treatment at the University of Udine between 2000 and 2012 were extracted. To identify predictors of endoscopic treatment outcome, a logistic regression analysis was carried out. Cox modeling was used to identify factors associated with mortality. We identified 142 patients who developed biliary complications: 83 of these patients had a successful endoscopic therapy, whereas 45 had a failure. Fourteen patients, who developed nonanastomotic biliary stricture, were excluded from the analysis. Patients with biliary complications who had pretransplant Model for End-Stage Liver Disease score more than 10 [odds ratio (OR) 3.88; 95% confidence interval (CI) 1.16-12.95; P = 0.03] and stent retention time more than 12 months (OR 6.45; 95% CI 2.14-19.42; P < 0.01) were less likely to respond to endoscopic therapy. In contrast, both dilatation and stenting procedures (OR 0.10; 95% CI 0.03-0.30; P < 0.01) and 10 Fr diameter stent placement (OR 0.21; 95% CI 0.07-0.70; P = 0.01) predicted favorable endoscopic treatment outcome. Time to the occurrence of biliary complications of more than 3 months [hazard ratio (HR) 0.24; 95% CI 0.10-0.56] and placement of five or more stents (HR 0.31; 95% CI 0.12-0.79) were found to be protective against mortality, whereas hepatic artery thrombosis was a significant risk factor for mortality (HR 13.88; 95% CI 4.08-47.25). We found endoscopic treatment to be less effective in patients with pretransplant Model for End-Stage Liver Disease score more than 10 and stent retention time more than 12, whereas dilatation and stenting procedure and 10 Fr diameter stent placement predicted a favorable outcome.