Endoscopic management of post-living donor liver transplant anastomotic biliary strictures: A quaternary care transplant center experience

Table 1 Clinical parameters of recipients developing post-liver transplant anastomotic biliary strictures

Parameter	n (%)
Demographics
Total	176
Male	130 (74)
Female	46 (26)
Male/female	2.82/1
Age distribution (year)
14-18	2 (1)
18-50	67 (38)
> 50	107 (61)
Co-morbid conditions
Diabetes mellitus	47 (27)
Hypertension	33 (19)
Ischemic heart disease	4 (2)
Chronic obstructive pulmonary disease	4 (2)
Indication for liver transplant
Hepatitis C virus	106 (60.23)
Cryptogenic cirrhosis	21 (11.93)
Hepatitis B virus	17 (9.66)
Metabolic dysfunction associated steatohepatitis	8 (4.55)
Budd-Chiari syndrome	7 (3.98)
Hepatitis B & delta virus coinfection	5 (2.84)
Wilson’s disease	3 (1.7)
Alcoholic liver disease	3 (1.7)
Primary biliary cholangitis	2 (1.1)
Hepatitis B & C virus coinfection	2 (1.1)
Primary hyperoxaluria	2 (1.1)
Hepatocellular carcinoma	37 (38.1)
Type of graft with anastomotic biliary stricture
Right lobe	168 (95.45)
Left lobe	8 (4.55)
Type of biliary reconstructions among 820 recipients
Single duct-duct anastomosis	631 (77)
Right lobe	531 (84)
Left lobe	100 (16)
Two separate duct – duct anastomosis	161 (20)
Two ducts on a single patch	28 (3)

Table 2 Post-living donor liver transplant anastomotic biliary stricture management outcomes

Stricture status	Total, n (%)	No. of ERCP (mean ± SD)	Duration between liver transplant to 1st ERCP (months)	Anastomosis, n (%)
				Single	2 ducts	2 ducts on a single patch
Patients completing the therapeutic course	114	5.18 ± 2.01	5.89 ± 5.58 (95%CI: 4.87-6.91)	67 (58.8)	36 (31.6)	11 (9.6)
Stricture resolution with endo therapy alone	102 (90.2)	5.04 ± 2.04	6 ± 5.77 (95%CI: 4.88-7.12)	58 (86.6)	33 (91.7)	11 (100)
Percutaneous transhepatic cholangioscopy referrals (cannulation failure/inability to traverse the stricture via ERCP)	11 (9.7)	6.27 ± 1.35	5.10 ± 3.65 (95%CI: 2.94-7.26)	8 (13.4)	3 (9.3)	-
Redo surgery	1 (0.9)	7.0	3.27	1 (100)	-	-
Combined percutaneous transhepatic cholangioscopy & endotherapy success rates	113 (99.1)	5.16 ± 2.02	5.92 ± 5.59 (95%CI: 4.89-6.95)	66 (98.5)	36 (100)	11 (100)
Stricture recurrence rates	15 (13.27)	7.5 ± 1.9	5.93 ± 4.57 (95%CI: 3.62-8.24)	6 (9.1)	7 (19.4)	2 (18.2)

ERCP: Endoscopic retrograde cholangiopancreatography.