Endoscopic Management of Biliary Leaks and Strictures After Living Donor Liver Transplantation: Optimizing Techniques for Successful Management

• Published in: Digestive diseases and sciences 2017, Vol.62 (1), p.244-252
• Main Authors: Elwir, Saleh, Thompson, Julie, Amateau, Stuart K., Trikudanathan, Guru, Attam, Rajeev, Hassan, Mohamed, Kandaswamy, Raja, Pruett, Timothy, Lake, John, Chinnakotla, Srinath, Freeman, Martin L., Arain, Mustafa A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anastomotic Leak - diagnostic imaging; Anastomotic Leak - surgery; Bile Duct Diseases - diagnostic imaging; Bile Duct Diseases - surgery; Biliary Tract Surgical Procedures - methods; Biochemistry; Cholangiopancreatography, Endoscopic Retrograde - methods; Cholangiopancreatography, Magnetic Resonance; Constriction, Pathologic - surgery; Databases, Factual; Donation of organs, tissues, etc; Endoscopy; Endoscopy, Digestive System; Female; Gastroenterology; Hepatectomy; Hepatology; Humans; Liver Transplantation; Living Donors; Male; Medicine; Medicine & Public Health; Methods; Middle Aged; Oncology; Original Article; Postoperative Complications - diagnostic imaging; Postoperative Complications - surgery; Recurrence; Retrospective Studies; Transplant Surgery; Transplantation of organs, tissues, etc; Treatment Outcome; Young Adult
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-016-4367-z

Background and Aims Biliary complications (BCs) occur in up to 40% of living donor liver transplant (LDLT) recipients. The aim of this study was to evaluate the efficacy of endoscopic therapy in the management of LDLT-related BCs. Methods A retrospective study of 100 LDLT recipients at a single transplant center over a 9-year period was conducted. BC was defined as a biliary leak and/or a stricture. Patient records were used to identify time to diagnosis, type of intervention, and time to resolution. Results BCs occurred in 46 (46%) patients; median follow-up was 4.6 years (range 5 days–9.3 years); and median time to diagnosis was 37.5 days (range 1 day–3.5 years). BCs were classified as a leak in 6 (6%), stricture in 22 (22%), and a leak + stricture in 18 (18%). ERCP was the initial treatment modality in 43/46 (93%) patients and was completed in 42/43 (98%). Three (6.5%) patients with a leak underwent surgery as the primary treatment approach. The median time to resolution of BCs was 91.5 days (range 21–367). Thirteen patients had a recurrence which was managed with endoscopic therapy alone. Conclusions Endoscopic therapy was successful in almost all patients (98%) and ERCP alone resulted in successful treatment in a higher proportion of patients (93%) than traditionally reported. Advanced endoscopic techniques obviate the need for PTC and/or surgery and allow successful management in almost all LDLT recipients presenting with BC and in patients with recurrence of strictures.