Published online May 15, 2017. doi: 10.4291/wjgp.v8.i2.77
Peer-review started: February 14, 2017
First decision: March 7, 2017
Revised: March 23, 2017
Accepted: April 18, 2017
Article in press: April 19, 2017
Published online: May 15, 2017
To identify factors predicting outcome of endoscopic therapy in bile duct strictures (BDS) post living donor liver transplantation (LDLT).
Patients referred with BDS post LDLT, were retrospectively studied. Patient demographics, symptoms (Pruritus, Jaundice, cholangitis), intra-op variables (cold ischemia time, blood transfusions, number of ducts used, etc.), peri-op complications [hepatic artery thrombosis (HAT), bile leak, infections], stricture morphology (length, donor and recipient duct diameters) and relevant laboratory data both pre- and post-endotherapy were studied. Favourable response to endotherapy was defined as symptomatic relief with > 80% reduction in total bilirubin/serum gamma glutamyl transferase. Statistical analysis was performed using SPSS 20.0.
Forty-one patients were included (age: 8-63 years). All had right lobe LDLT with duct-to-duct anastomosis. Twenty patients (48.7%) had favourable response to endotherapy. Patients with single duct anastomosis, aggressive stent therapy (multiple endoscopic retrograde cholagiography, upsizing of stents, dilatation and longer duration of stents) and an initial favourable response to endotherapy were independent predictors of good outcome (P < 0.05). Older donor age, HAT, multiple ductal anastomosis and persistent bile leak (> 4 wk post LT) were found to be significant predictors of poor response on multivariate analysis (P < 0.05).
Endoscopic therapy with aggressive stent therapy especially in patients with single duct-to-duct anastomosis was associated with a better outcome. Multiple ductal anastomosis, older donor age, shorter duration of stent therapy, early bile leak and HAT were predictors of poor outcome with endotherapy in these patients.
Core tip: Living donor liver transplantation (LDLT) is the definitive treatment for end stage liver disease. Biliary complications complicating LDLT is a major source of morbidity and mortality. Anastomotic strictures seen with LDLT are notorious for gross phenotypical variations which have led to variable results with endotherapy as a treatment option in these patients. In this study, we have looked into the factors that can predict the response with endotherapy (endoscopic retrograde cholangiography, sphincterotomy and stent placement) thereby allowing for better prognostication and selection of patients in order to optimize patient care.