Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome

Table 1 Baseline characteristics of the patient population stratified according to response to endotherapy

Parameters	Total (n = 41)	Complete response (n = 20)	Partial response (n = 14)	No response (n = 7)
Recipient mean age (year ± SD)	40.02 ± 15.45	37.5 ± 17.03	41.0 ± 14.3	45.29 ± 13.15
Donor mean age (year ± SD)	39.9 ± 8.9	38.5 ± 6.85	39.86 ± 11.2	44.0 ± 9.03
Recipient gender - male, n (%)	36 (87.8)	16 (80)	14 (100)	6 (85.7)
Donor gender - male, n (%)	9 (22)	4 (20)	4 (28.5)	1 (14.2)
Transplant setting, n (%)
CLD	32 (78)	14 (70)	12 (85.7)	6 (85.7)
ALF	9 (22)	6 (30)	2 (14.3)	1 (14.3)
Etiology of CLD (n = 32)
Alcohol	12 (37.5)	4 (33.3)	6 (50)	2 (16.7)
Cryptogenic	13 (40.6)	6 (46.1)	5 (38.4)	2 (15.5)
Others (Wilsons, hepatitis B, hepatitis C, autoimmune)	7 (21.8)	3 (42.8)	2 (28.6)	2 (28.6)
MELD	23.45 ± 6.4	25.07 ± 7.2	22.46 ± 4.75	21.83 ± 6.52
Intra-operative variables
Cold Ischemia time (secs) (mean ±)	51.5 ± 29.2	53.3 ± 34.4	54.08 ± 25.6	43.57 ± 28.4
Blood transfusions (mean ±)	4.1 ± 2.8	4.3 ± 2.3	4.3 ± 3.5	3.2 ± 2.2
Post op complications
Hepatic artery thrombosis, n (%)	5 (12.2)	0 (0)	3 (60)	2 (40)
Bile leak	26 (65)	12 (60)	10 (71.4)	4 (57.1)
Mean interval between LT and leak (d)	18.4	20.85	12.6	5.6
Persistent bile leak > 4 wk, n (%)	14 (34.1)	2 (14.2)	8 (57.1)	4 (28.7)
Clinical presentation, n (%)
Cholangitis	15 (36.6)	6 (30)	7 (42.1)	2 (13.4)
Pruritus alone	16 (39)	7 (43.75)	4 (25)	5 (31.25)
Jaundice	16 (39)	5 (31.25)	6 (37.5)	5 (31.25)

CLD: Chronic liver disease; ALF: Acute liver failure; MELD: Model for end-stage liver disease.

Table 2 Impact of endotherapy protocol and morphology of the stricture on therapeutic efficacy

Endotherapy details	Total (n = 41)	Complete response (n = 20)	Partial/no response (n = 21)
Mean time interval between LT and first ERC (d)
Mean No. of ERCa	368.3	352.6	444.1
Mean Stricture length (cm)	2.85	3.01	1.71
Initial response to ERC, n (%)	0.84	0.85	0.82
Aggressive stent therapyab	29 (70.7)	17 (85)	12 (57.1)
Mean duration of stentinga (mo)	23 (39)	16 (69.5)	7 (23.3)
Morphology of the stricture	5.75	16.4	6.8
Mean length of stricture (mm)	84	82	85
Type of anastomosis (Figure 1), n (%)
Type I	13	10 (76.9)	3 (23.1)
Type II	16	9 (56.25)	7 (43.75)
Type III	5	1 (20)	4 (80)
Type IV	7	0 (14.2)	7 (100)

^aP value < 0.05;

^bAggressive stent therapy involves sphincterotomy, serial dilatation of stricture and increase in number/size of stents. LT: Liver transplantation; ERC: Endoscopic retrograde cholangiography.