Management Of Biliary Complications Research Articles

Management of biliary complications after LDLT.

Biliary complications (BC) in the recipient continue to be an as yet, unresolved issue following living donor liver transplantation (LDLT). Bile leaks (BL) and biliary anastomotic strictures (BAS) are the most common BCs, with the latter contributing to close to 80%. With increasing expertise, endoscopic treatment with endoscopic retrograde cholangiography (ERC) [the first-line treatment] and percutaneous transhepatic cholangiography (PTC) with percutaneous transhepatic biliary drainage (PTBD) alone or in combination with ERC lead to successful management in a majority of these cases. However, prediction of difficulty of endoscopic success in biliary strictures, optimal duration of indwelling stents and their planned removal, management options in high-grade strictures (HGS) and the long-term outcome of patients requiring intervention for BC's are still unanswered questions in this setting. This review will try to summarise pertinent issues, novel insights and finally propose basic principles to be adhered to when dealing with the gamut of possible biliary complications after LDLT.

Management of biliary complications in liver transplant recipients using a fully covered self-expandable metal stent with antimigration features.

Following liver transplant (LT) with duct-to-duct anastomosis, biliary strictures and leaks are typically managed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting. While multiple side-by-side plastic stents are typically used for management of anastomotic strictures, fully covered self-expandable metal stents (FCSEMS) can be used to decrease the number of ERCPs with longer periods of stent patency. The risk of migration can limit their use. FCSEMS with antimigration fins to manage benign biliary complications following LT may provide stricture resolution with limited adverse events (AEs). Single center retrospective study of LT patients who required FCSEMS from 1/2014 to 4/2022. Primary outcomes included stricture resolution and recurrence. Secondary outcomes were stent migration, occlusion, removability, and number of ERCPs. Forty-three patients (mean age 55.5 years) with anastomotic strictures (N.=37), bile leaks (N.=4) or both (N.=2) were included. The median time from LT to FCSEMS placement was 125 days. Within one year of LT, 31 patients required intervention; early intervention at less than 30 and 90 days was needed in 7 and 19 patients, respectively. The median length of follow-up was 816.5 days. Stricture resolution was seen in 35 patients (81%) after a median stent dwell time of 130.5 days; recurrence occurred in 8 patients. There were three instances of partial stent migration that did not require reintervention or interfere with removability. The mean number of ERCPs required was 2.5. The use of a FCSEMS with antimigration features yields effective stricture resolution with longer stent dwell times and fewer ERCPs.

Management of Biliary Complications in Liver Transplant Recipients with Duct-To-Duct Anastomosis: A Single-Center Experience.

The aims of this study were to investigate biliary complications in liver transplant recipients with choledochocholedocho stomy anastomosis, to identify the risk factors for the development of such complications, and to evaluate the success of endoscopic approaches in liver transplant recipients. Between January 2013 and May 2021, a total of 238 patients with liver diseases underwent liver transplantation: 174 recipients undergoing choledochocholedochostomy anastomosis were included in the analysis. Their median age was 54.0 years. The median posttransplant follow-up period was 29 months. Hepatitis B virus infection (33%) was the most common indication for liver transplantation. Most patients (87%) received living donor liver transplantation. The overall prevalence of posttransplant biliary complications was 31%. Anastomotic biliary strictures were the most common biliary complications (72%), followed by biliary leakage (13%). The median time between endoscopic retrograde cholangiography and liver transplantation was 4 months, with a mean of 3 ± 1.6 sessions. Endoscopic retrograde cholangiography-guided drainage and balloon dilation with or without stent placement was the most common treatment modalities for recipients with biliary strictures. The overall success rate of endoscopic treatment modalities was 83.3%, with 65% of the recipients exhibiting complete biochemical and endoscopic responses. The response did not differ significantly between living donor liver transplantation and cadaveric donor liver transplant recipients (P > .05). Three recipients required revision surgery for biliary complication repair. Six patients died due to biliary sepsis. Biliary stricture and leakages were the most common biliary complications after liver transplantation. Endoscopic treatment was successful in most recipients.

Efficiency of percutaneous transhepatic cholangioscopy in the treatment of biliary complications after liver transplantation

BackgroundPercutaneous transhepatic cholangioscopy (PTCS) has provided an alternative therapeutic option for handling refractory biliary complications in liver transplanted recipients. This study aimed to evaluate short-term PTCS efficiency in the management of biliary complications following liver transplantation. MethodsClinical data of 25 patients who received therapeutic PTCS due to biliary complications after liver transplantation were retrospectively analyzed. ResultsTherapeutic PTCS was successfully performed in 25 patients. Biliary complications were anastomotic strictures in seven cases, intrahepatic cholangiolithiasis in four cases, extra-and intrahepatic cholangiolithiasis in three cases, choledocholithiasis complicated with anastomotic strictures in four cases, intrahepatic cholangiolithiasis complicated with non-anastomotic strictures in one case, intrahepatic cholangiolithiasis complicated with anastomotic strictures in five cases, intrahepatic cholangiolithiasis complicated with anastomotic strictures and ischemic cholangitis in one case. The median time between liver transplantation and first PTCS was 24 months, and median times of PTCS was 2.6. Clinical manifestations were significantly improved in most patients after PTCS, and biliary complications were successfully managed through PTCS in 15 cases, which were partially effective in eight cases and ineffective in two cases. PTCS was more effective in tackling anastomotic strictures and cholangiolithiasis. ConclusionPTCS was an effective therapeutic modality for treating refractory biliary complications following liver transplantation.

Management of Biliary Complications after Living Donor Liver Transplantation. The Initial Experience of a Single Center

Management of Biliary Complications after Living Donor Liver Transplantation. The Initial Experience of a Single Center

Management of Biliary Complications in Hilar Plasmacytoma: A Case Report

Introduction: Plasma cell neoplasms present different clinical forms that can delay or result in erroneous diagnosis. Single plasmacytoma is a rare condition that presents no other symptoms than those derived from the primary lesion and that can result in challenging treatment strategies. Case Presentation: We present a case of a 50-year-old female patient with previous plasma cell leukemia and allogeneic stem cell transplantation who was admitted with obstructive jaundice. An MRI showed a hepatic hilar mass. A PET-CT was performed and showed no recurrence of disease. The patient was submitted to bilateral endoscopic biliary drainage. Following the procedure, the patient presented abdominal pain and was diagnosed of acute cholecystitis that was treated with a cholecystostomy and antibiotic treatment. An endoscopic ultrasound (EUS) was performed and fine needle aspiration (FNA) revealed atypical plasma cells which confirmed biliary extramedullary plasmacytoma. The patient was started on chemotherapy (pomalidomide + dexamethasone and cyclophosphamide) during 8 months. A CT scan was then performed and showed complete radiologic response. The biliary stents were removed and the patient is currently alive and disease-free. Conclusion: Management of extramedullary plasmacytomas can be challenging as they can mimic other conditions. Endoscopic and percutaneous approach should be considered as chemotherapy is the mainstay of treatment.

Biliary complications in recipients of living donor liver transplantation: A single-centre study.

BACKGROUNDBiliary complications (BCs) after liver transplantation (LT) remain a considerable cause of morbidity, mortality, increased cost, and graft loss. AIMTo investigate the impact of BCs on chronic graft rejection, graft failure and mortality.METHODSFrom 2011 to 2016, 215 adult recipients underwent right-lobe living-donor liver transplantation (RT-LDLT) at our centre. We excluded 46 recipients who met the exclusion criteria, and 169 recipients were included in the final analysis. Donors’ and recipients’ demographic data, clinical data, operative details and postoperative course information were collected. We also reviewed the management and outcomes of BCs. Recipients were followed for at least 12 mo post-LT until December 2017 or graft or patient loss.RESULTSThe overall incidence rate of BCs including biliary leakage, biliary infection and biliary stricture was 57.4%. Twenty-seven (16%) patients experienced chronic graft rejection. Graft failure developed in 20 (11.8%) patients. A total of 28 (16.6%) deaths occurred during follow-up. BCs were a risk factor for the occurrence of chronic graft rejection and failure; however, mortality was determined by recurrent hepatitis C virus infection. CONCLUSIONBiliary complications after RT-LDLT represent an independent risk factor for chronic graft rejection and graft failure; nonetheless, effective management of these complications can improve patient and graft survival.

Evaluation and management of biliary complications after pediatric liver transplantation: pearls and pitfalls for percutaneous techniques.

In pediatric liver transplantation, bile duct complications occur with a greater incidence than vascular anastomotic dysfunction and represent a major source of morbidity and mortality. While surgical re-anastomosis can reduce the need for retransplantation, interventional radiology offers minimally invasive and graft-saving therapies. The combination of small patient size and prevailing Roux-en-Y biliary enteric anastomotic techniques makes endoscopic retrograde cholangiopancreatography difficult if not impossible. Expertise in percutaneous management is therefore imperative. This article describes post-surgical anatomy, pathophysiology and noninvasive imaging of biliary complications. We review percutaneous techniques, focusing heavily on biliary access and interventions for reduced liver grafts. Subsequently we review the results and adverse events of these procedures and describe conditions that masquerade as biliary obstruction.

Biliary complications after liver transplantation: current perspectives and future strategies.

Liver transplantation (LT) is a life-saving therapy for patients with end-stage liver disease and with acute liver failure, and it is associated with excellent outcomes and survival rates at 1 and 5 years. The incidence of biliary complications (BCs) after LT is reported to range from 5% to 20%, most of them occurring in the first three months, although they can occur also several years after transplantation. The aim of this review is to summarize the available evidences on pathophysiology, risk factors, diagnosis and therapeutic management of BCs after LT. a literature review was performed of papers on this topic focusing on risk factors, classifications, diagnosis and treatment. Principal risk factors include surgical techniques and donor's characteristics for biliary leakage and anastomotic biliary strictures and vascular alterations for non- anastomotic biliary strictures. MRCP is the gold standard both for intra- and extrahepatic BCs, while invasive cholangiography should be restricted for therapeutic uses or when MRCP is equivocal. About treatment, endoscopic techniques are the first line of treatment with success rates of 70-100%. The combined success rate of ERCP and PTBD overcome 90% of cases. Biliary leaks often resolve spontaneously, or with the positioning of a stent in ERCP for major bile leaks. BCs influence morbidity and mortality after LT, therefore further evidences are needed to identify novel possible risk factors, to understand if an immunological status that could lead to their development exists and to compare the effectiveness of innovative surgical and machine perfusion techniques.

Management of biliary complications after adult-to-adult living donor liver transplantation. Initial experience in a latin american center

Presenter: Sergio Riveros MD | Pontificia Universidad Católica de Chile Background: Living donor liver transplantation (LDLT) is a complex therapeutic alternative that requires a specialized multidisciplinary team with the capacity to resolve complications. The number of anastomosed ducts has an impact on the rate of postoperative biliary complications, but the literature is still scarce. The objective of this study was to describe early and late postoperative biliary complications with a focus on therapeutic management in the initial experience of a LDLT program. Methods: Non-concurrent cohort study at a Pontificia Universidad Católica de Chile. All patients who underwent adult-to-adult LDLT were included from 2016 to 2020. Patients were divided into two groups according to the number of bile duct anastomoses (single duct, group A; and two or three ducts, group B). Demographic, perioperative, postoperative outcomes regarding early and late biliary complications (>2 months), treatment, major complications (Clavien-Dindo III-IV), mortality, and survival were evaluated and compared between groups. Results: single bile duct was anastomosed in 63.3% (n = 19), two bile ducts in 33.3% (n = 10) and three bile ducts in 3.3% (n = 1). Duct-to-duct (DD) anastomosis was performed in 56.7% (n = 17), hepaticojejunostomy (HJ) in 33.3% (n = 10) and combined in 10% (n = 3). Major complications were reported in 46.7% (n = 14), median length of postoperative stay was 15.5 days (7-46) and median follow-up 17 months (0.4-53.5). Overall graft and patient survival was 87% at 24 months. Group A (n = 19) had major complications in 21% (n = 4), early biliary complications in 15.8% (n = 3) and late biliary strictures in 26.7% (n = 4). None required percutaneous drainage, 5.3% surgical drainage (n = 1) and 10.5% re-anastomosis to a Roux-en-Y HJ (n = 2). They underwent ERCP in 26.7% (n = 4) and percutaneous transhepatic internal-external drainage in 6.7% (n = 1). Four patients (21.1%) had early mortality and one patient (6.7%) late mortality, all unrelated to biliary complications. Group B (n = 11) had major complications in 90.9% (n = 10), early biliary complications in 81.8% (n = 9) and late biliary strictures in 54.5% (n = 6). They required percutaneous drainage in 27.3% (n = 3), surgical drainage in 9.1% (n = 1), endoscopic transgastric drainage in 9.1% (n = 1), duct-to-duct reinforcement (n = 1) and re-anastomosis to Roux-en-Y HJ (n = 4). They underwent ERCP in 27.3% (n = 3) and percutaneous transhepatic internal-external drainage in 18.2% (n = 2). All patients are alive with 100% graft and patient survival. Conclusion: Living donor liver transplantation is a challenging treatment that requires a specialized high-volume center with the ability to rescue postoperative complications. The number of reconstructed ducts affects the rate of early biliary complications, without an impact on graft and patient survival. In our experience, patients with 2-3 graft bile ducts had a high rate of biliary complications, but with adequate management, all patients are alive with functioning grafts. Expertise in advanced endoscopy, interventional radiology, and complex reoperations are crucial to achieve excellent outcomes.

Management of Postcholecystectomy Biliary Complications: A Narrative Review.

Every year approximately 750,000 cholecystectomies are performed in the United States, most of those are performed laparoscopically. Postcholecystectomy complications are not uncommon and lead to increased morbidity and financial burden. Some of the most commonly encountered complications with laparoscopic cholecystectomy include biliary injury (0.08%-0.5%), bile leak (0.42%-1.1%), retained common bile duct stones (0.8%-5.7%), postcholecystectomy syndrome (10%-15%), and postcholecystectomy diarrhea (5%-12%). Endoscopy has an important role in the diagnosis and management of biliary complications and in many cases can provide definitive management. There is no consensus on the best therapeutic approach for biliary complications. Therefore, biliary complications should be approached by an experienced multidisciplinary team. It is important for the gastroenterologist to be familiar with the management of such complications (Visual Abstract, Supplemental Digital content 1, http://links.lww.com/AJG/B544).

Analysis of Adult to Adult Living Donor Liver Transplant Biliary Complications Using Non-Stented Biliary Anastomosis

Abstract Background biliary tract reconstruction during liver transplantation (LT) is the final technical step and the cornerstone of the procedure and is often performed by a duct-to-duct anastomosis. Rarely, recipient and donor biliary stump discrepancies or liver disease-related reasons could lead to a hepaticojejunostomy. Purpose To clarify the role of non-stented biliary anastmosis in reducing biliary complications in adult to adult living donor liver transplant and ending the era of using intraductal removable stent. Patients and Methods this is a retrospective Single arm Cohort study. Our study was performed in Egypt by following the results of 80 cases of adult to adult living donor liver transplant using non-stented biliary anastomosis in Airforce specialized hospitals and Nasser institute in Cairo. Study period was from July 2015 to June 2018. Results The rate of biliary complications in non-stented patients was 23/80 (27%), and (27%) is subdivided as follow; (18%-strictures, 9%-leaks, and 1%-mixed), ) . All biliary complications had been treated with successful outcome representing 20/23(87%), while persistent biliary complication was in 3 (13%). Treatments used in biliary complications were (ERCP n = 22, PTC n = 5, Rendezvous n = 2, Surgical biliary-reconstruction n = 2). Conclusion Stentless biliary anastomosis is a well established and trusted method in biliary reconstruction in adult living donor liver transplant and has a less complications than stented duct to duct biliary anastomosis and biliary-enteric anastomosis and allow better management of biliary complication if occurred.

Endoscopic Management of Biliary Complications after Liver Transplant

AbstractOrthotropic liver transplant (OLT) is the definitive treatment for patients with end stage liver disease of all etiologies. Biliary complications are common after OLT and living donor liver transplant (LDLT). Approximately, 15% of patients undergoing deceased donor liver transplant develop strictures and this number is even higher in LDLT recipients (28–32%).1 2 Common biliary complications include anastomotic and non-anastomotic strictures, bile leaks, biliary casts, and stones.3 Endoscopic therapy has become the mainstay of management of these biliary conditions. Endoscopic therapy involves sphincterotomy, dilation, and stent deployment to maintain patency of the bile duct and provide adequate drainage. This article will review current literature regarding endoscopic management of biliary complications after liver transplant and discuss recent endoscopic advances that can reduce the need for reoperation.

Is Surgery Necessary? Endoscopic Management of Post-transplant Biliary Complications in the Modern Era

BackgroundBiliary complications are common following liver transplantation (LT) and traditionally managed with Roux-en-Y hepaticojejunostomy. However, endoscopic management has largely supplanted surgical revision in the modern era. Herein, we evaluate our experience with the management of biliary complications following LT. MethodsAll LTs from January 2013 to June 2018 at a single institution were reviewed. Patients with biliary bypass prior to, or at LT, were excluded. Patients were grouped by biliary complication of an isolated stricture, isolated leak, or concomitant stricture and leak (stricture/leak). ResultsA total of 462 grafts were transplanted into 449 patients. Ninety-five (21%) patients had post-transplant biliary complications, including 56 (59%) strictures, 28 (29%) leaks, and 11 (12%) stricture/leaks. Consequently, the overall stricture, leak, and stricture/leak rates were 12%, 6%, and 2%, respectively. Endoscopic management was pursued for all stricture and stricture/leak patients, as well as 75% of leak patients, reserving early surgery only for those patients with an uncontrolled leak and evidence of biliary peritonitis. Endoscopic management was successful in the majority of patients (stricture 94%, leak 90%, stricture/leak 90%). Only six patients (5.6%) received additional interventions—two required percutaneous transhepatic cholangiography catheters, three underwent surgical revision, and one was re-transplanted. ConclusionsEndoscopic management of post-transplant biliary complications resulted in long-term resolution without increased morbidity, mortality, or graft failure. Successful endoscopic treatment requires collaboration with a skilled endoscopist. Moreover, multidisciplinary transplant teams must develop treatment protocols based on the local availability and expertise at their center.

A Review on the Management of Biliary Complications after Orthotopic Liver Transplantation.

Orthotopic liver transplantation is the definitive treatment for end-stage liver disease and hepatocellular carcinomas. Biliary complications are the most common complications seen after transplantation, with an incidence of 10–25%. These complications are seen both in deceased donor liver transplant and living donor liver transplant. Endoscopic treatment of biliary complications with endoscopic retrograde cholangiopancreatography (commonly known as ERCP) has become a mainstay in the management post-transplantation. The success rate has reached 80% in an experienced endoscopist’s hands. If unsuccessful with ERCP, percutaneous transhepatic cholangiography can be an alternative therapy. Early recognition and treatment has been shown to improve morbidity and mortality in post-liver transplant patients. The focus of this review will be a learned discussion on the types, diagnosis, and treatment of biliary complications post-orthotopic liver transplantation.

Biliary Complication in Pediatric Liver Transplantation: a Single-Center 15-Year Experience

BackgroundThe incidence and several risk factors of biliary complication (BC) following pediatric liver transplantation (LT) are widely known, but data on long-term outcomes and management is limited. This retrospective study aimed to investigate the incidence, associated risk factors, management, and outcomes of early and late BC in pediatric LT. MethodsThis study enrolled 134 pediatric patients (< 18 years old) who underwent LT at a tertiary care center in Taiwan between January 2001 and December 2015. Diagnosis of BC was based on clinical, biochemical, and radiologic examinations. Clinical data and chart records were reviewed and compared between the groups. ResultsAmong the 134 children, 21 children (15.7%) had BC after LT. Nine children had early complications, including leakage plus stricture (n = 2), stricture only (n = 2), and leakage only (n = 5). Twelve children had late BC; all of whom had anastomotic stricture. Of the 21 patients with BC, 11 patients (52.4%) were treated without surgery. The median time of first treatment for BC was 6.5 months (range, 11 days to 6.2 years). Five of the 9 patients with early complications and two of the 12 patients with late complications died of biliary tract infection. The major risk factors of BC in pediatric LT were (1) recipient age > 2 years, (2) Kasai portoenterostomy revision, and (3) hepatic artery thrombosis. ConclusionsSeveral risk factors of BC in pediatric LT were identified. Children with early BC appeared to have relatively unfavorable outcomes. However, late BC treated by either radiological or surgical methods appeared to have a relatively good long-term prognosis.

Endoscopic retrograde cholangiopancreatography in the management of biliary complications after orthotopic liver transplantation.

biliary complications are frequent after orthotopic liver transplantation and the management of these complications with endoscopic retrograde cholangiopancreatography (ERCP) is available. The aims of the study were to analyze the experience in the endoscopic management of biliary complications after liver transplantation in a third level center. Furthermore, the factors associated with higher rates of technical and clinical success were determined. this was an observational retrospective study of ERCPs performed in patients with biliary complications after liver transplantation between February 2012 and January 2017. The factors analyzed were: demographics, time between transplantation and ERCP, indications for ERCP, strategy of stenting (only plastic stents, only self-expandable metallic stents, plastic followed by metallic stents and metallic followed by plastic stents), technical and clinical success and complications. one hundred and sixty-eight endoscopies were performed in 58 patients. Thirty-three patients (56.9%) presented with early complications. The most frequent indication for ERCP was anastomotic stenosis (57.8%). Technical success in the first ERCP was achieved in 43 patients (74.1%). Early onset of biliary complications was associated with higher rates of technical success (OR: 6.49; p: 0.036). Clinical success was obtained in 36 cases (62.1%). Patients with early complications had a higher probability of having good clinical response (OR: 11.16; p: 0.033). The results were worse in patients with only plastic stents (50% of clinical success). Eleven complications were observed among 168 ERCPs (6.54%), including two pancreatitis, five bleeding events, three cholangitis and one micro-perforation. ERCP is safe and useful in the management of biliary complications after liver transplantation. Early onset of complications is associated with better results. Some patients will need repeated procedures to obtain a good clinical response.

Adult liver transplantation in Johannesburg, South Africa (2004 - 2016): Balancing good outcomes, constrained resources and limited donors.

Liver transplantation is the standard of care for the treatment of liver failure worldwide, yet millions of people living in sub-Saharan Africa remain without access to these services. South Africa (SA) has two liver transplant centres, one in Cape Town and the other in Johannesburg, where Wits Donald Gordon Medical Centre (WDGMC) started an adult liver transplant programme in 2004. To describe the outcomes of the adult liver transplant programme at WDGMC. This was a retrospective review of all adult orthotopic liver transplants performed at WDGMC from 16 August 2004 to 30 June 2016 with a minimum follow-up of 6 months. The primary outcome was recipient and graft survival and the effect of covariates on survival. Kaplan-Meier survival analysis included all adults who underwent their first transplant for end-stage liver disease (ESLD) (N=275). Proportional hazards regression analysis using hazard ratios (HRs) was conducted to determine which covariates were associated with a significantly increased risk of mortality. A total of 297 deceased-donor liver transplants were performed during the study period; 19/297 (6.4%) were for acute liver failure (ALF) and the remainder were for ESLD. The median age of recipients was 51 years (interquartile range 41 - 59), and two-thirds were male. The most common cause of ESLD was primary sclerosing cholangitis. The median follow-up was 3.2 years, and recipient survival was characterised in the following intervals: 90 days = 87.6% (95% confidence interval (CI) 83.1 - 91.0), 1 year = 81.7% (95% CI 76.6 - 85.8), and 5 years = 71.0% (95% CI 64.5 - 76.5). Allograft survival was similar: 90 days = 85.8% (95% CI 81.1 - 89.4), 1 year = 81.0% (95% CI75.8- 85.2), and 5 years = 69.1% (95% CI 62.6 - 74.7). The most significant covariates that impacted on mortality were postoperative biliary leaks (HR 2.0 (95% CI 1.05 - 3.80)), recipient age &gt;60 years at time of transplant (HR 2.06 (95% CI 1.06 - 3.99)), theatre time &gt;8 hours (HR3.13 (95% CI 1.79 - 5.48)), and hepatic artery thrombosis (HR 5.58 (95% CI 3.09 - 10.08)). The most common infectious cause of death was invasive fungal infection. This study demonstrates that outcomes of the adult orthotopic liver transplant programme at WDGMC are comparable with international transplant centres. Management of biliary complications, early hepatic artery thrombosis and post-transplant infections needs to be improved. Access to liver transplantation services is still extremely limited, but can be improved by addressing the national shortage of deceased donors and establishing a national regulatory body for solid-organ transplantation in SA.

Management of biliary complications in DCD type IIA liver transplantation

Introduction: Biliary complications (BC) are a frequent obstacle in liver transplantation, with a significant impact on long term results and QoL, and a complex and often unsatisfactory treatment. Grafts obtained from donation after cardiac death (DCD) type IIA are especially susceptible to biliary damage, therefore the management of BC acquires a significant relevance. Materials and methods: Retrospective analysis of the DCD Maastricht type IIA LT series in 12 de Octubre Hospital, from January 2006 to December 2016, with a minimal 1 year follow up. Results: 75 LT from DCD type IIA were performed, with a rate of BC of 36%. 2 (2.7%) patients developed a biliary leak, 10 (13.3%) developed anastomotic stricture (AS) and 15 (20%) ischemic cholangiopathy (IC). Both cases of biliary leak required reintervention. Out of the 10 cases of AS, only 4 associated IC. All patients were initially managed with PTC, a median of 5 procedures per patient (2-17); successfully in 4 of the 6 patients with isolated AS and in 2 of the 4 patients with IC. 3 patients required surgery, 1 patient died from oesophageal carcinoma. In patients diagnosed with IC, PTC was performed in 14 (93.3%), a median of 7.5 procedures per patient (1–21), and success rate of 50% (7). ERCP was performed in 2 cases. 6 patients required surgery (3 cases of retransplantation and 3 hepaticojejunostomies). Conclusion: PTC is a moderately successful initial treatment in cases of AS and IC after DCD IIA LT. 50% of patients in our series required surgical treatment.

4:21 PM Abstract No. 120 Interventional radiology in the management of biliary complications in pediatric liver transplants: a single-center experience

To demonstrate the important role played by interventional radiology in the management of biliary complications following pediatric liver transplantation, helping patients avoid reoperation. We studied two hundred thirteen liver transplants at a single pediatric hospital in a large metropolitan area between 2006 and 2016 in 199 patients with a median age of 3.1 years. Patients with biliary strictures were managed percutaneously by interventional radiology or surgically by the transplant team. The location of biliary stricture (intrahepatic ducts or at the anastomosis), duration of internal and external drainage, number of balloon dilations, balloon diameter, time interval between dilations and success of percutaneous treatment were recorded. Patients with bile leaks were also identified and duration and success of biliary drainage was recorded. Thirty-one patients (14.5%) developed a biliary obstruction or biliary stricture and eight (3.7%) developed a bile leak. Technical success was achieved in 26 of 28 strictures (92.8%). Clinical success was achieved in 15 of the 21 anastomotic strictures (71.4%) and all 6 patients with intrahepatic strictures (100%). Larger maximum balloon diameter was associated with treatment failure, 6.25 mm vs. 4.5 mm in the successfully treated group using an independent t-test (P = .009). Patients who required more than 3 dilations were associated with decreased likelihood of success. (P = .006). Of the 3 patients with bile leaks who required percutaneous transhepatic cholangiography by IR, the biliary system was successfully accessed in 2 patients for a technical success rate of 66%. Clinical success was achieved in both patients for a 100% clinical success rate. Our study demonstrates the important role of interventional radiology in the management of patients with biliary complications. For a high percentage of patients, percutaneous treatment of biliary complications helps patients avoid reoperation.