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.
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.
Authors: W R Kim; J R Lake; J M Smith; M A Skeans; D P Schladt; E B Edwards; A M Harper; J L Wainright; J J Snyder; A K Israni; B L Kasiske Journal: Am J Transplant Date: 2015-01 Impact factor: 8.086
Authors: W M Alazmi; E L Fogel; J L Watkins; L McHenry; J A Tector; J Fridell; P Mosler; S Sherman; G A Lehman Journal: Endoscopy Date: 2006-06 Impact factor: 10.093
Authors: Kenneth S H Chok; Albert C Y Chan; William W Sharr; Tan To Cheung; James Y Y Fung; See Ching Chan; Chung Mau Lo Journal: J Gastroenterol Hepatol Date: 2016-01 Impact factor: 4.029
Authors: Jae Hyuck Chang; In Seok Lee; Jong Young Choi; Seung Kyoo Yoon; Dong Goo Kim; Young Kyoung You; Ho Jong Chun; Dong Ki Lee; Myung-Gyu Choi; In-Sik Chung Journal: Gut Liver Date: 2010-06-16 Impact factor: 4.519
Authors: Jörg G Albert; Natalie Filmann; Julia Elsner; Christian Moench; Jörg Trojan; Jörg Bojunga; Christoph Sarrazin; Mireen Friedrich-Rust; Eva Herrmann; Wolf Otto Bechstein; Stefan Zeuzem; Wolf Peter Hofmann Journal: Liver Transpl Date: 2013-06 Impact factor: 5.799
Authors: M Harputluoglu; U Demirel; A R Caliskan; A Selimoglu; Y Bilgic; M Aladag; M A Erdogan; R Dertli; Y Atayan; S Yilmaz Journal: Langenbecks Arch Surg Date: 2019-07-20 Impact factor: 3.445