Biliary strictures complicating living donor liver transplantation: Problems, novel insights and solutions

Figure 1 Management algorithm used in our centre for the treatment of biliary strictures. ¹Aggressive endotherapy protocols: Multiple ERC with stricture dilatation and gradual upsizing of stents done every 3 mo for a minimum period of 1 yr; ²MDR = MRC ductal ratio calculated as maximum diameter of the recipient hepatic duct divided by the maximum diameter of the donor bile duct as seen on an MRC done at the time of presentation with clinical symptoms and biochemical alterations. The cut-off of 1.15 was computed after an internal review of our patient data showed a sensitivity and specificity of > 90% for the diagnosis of a functionally significant stricture (unpublished data). ERC: Endoscopic retrograde cholangiography; LDLT: Living donor liver transplant; MRC: Magnetic resonance cholangiography.

Figure 2 Fully-covered modified self-expanding metal stent used in the management of biliary strictures complicating Living donor liver transplantation. The Kaffes stent (Taewoong Medical, Seoul, South Korea) is shown.