Anastomotic bilio-biliary stricture after adult liver transplantation: A retrospective study over 20 years in a single center

Management of anastomotic biliary stricture after liver transplantation and impact on survival

“…This single-center retrospective study found a rate of AS after transplantation of 24.9%; this corresponds to the high end of the incidence seen in the literature, which varies from 5 to 35%. [6][7][8]24,25,[27][28][29][30][31] This can be explained by the fact that there is no consensus on the definition of post-transplantation AS, as many studies do not specify a definition of AS or do so very imprecisely. 13,27,[32][33][34][35][36] The median time to the occurrence of stenosis is 3 months, but 69.6% of AS occur within 6 months of the transplantation.…”

“…44 The MELD score was found to be a risk factor of anastomotic biliary strictures in a recent study. 6 This can undoubtedly be explained by the fact that transplantation in this type of patient is often very hemorrhagic, with blood pressure variations, possibly even states of shock, leading to suffering and poor tissue perfusion, which promotes AS through an ischemic process.…”

“…Several authors have studied the risk factors of survival [13][14][15][16][17][18][19] and researched means of prevention, without success. 6,9,11,12,20 However, many problems persist in the study of AS: 1) No study has a standardized definition of AS, which makes it difficult to compare the results of their treatment; 2) No study has defined the criteria for failure of non-surgical treatment (interventional radiological and/or endoscopic) that requires a switch to surgical treatment with the performance of a bilio-enteric anastomosis. 21 Indeed, progress in endoscopy and interventional radiology 22,23 have led to the non-surgical management that is now recognized as first-line treatment; but this non-surgical management often involves long treatment over several months with multiple procedures requiring frequent hospitalizations, which alters patients' quality of life and leads to high health care costs; 3) Publications that study the impact of strictures on the survival of patients and grafts remain controversial, 8 as some authors consider that biliary complications increase mortality and decrease survival of the grafts, 24 and other studies have not found significant differences.…”

Post-Transplantation Cytomegalovirus Infection Interplays With the Development of Anastomotic Biliary Strictures After Liver Transplantation

“…Overall, risk factors are multiple as they are related to recipient and donor characteristics and transplantation techniques. Consequently, reported risk factors are highly variable and conflict between existing series ( 9 , 7 , 10 , 11 ). Such a heterogeneity across the literature is explained in part by the lack of consensus on an ABS definition and the heterogeneity of included patients in terms of recipient severity, graft type, biliary reconstruction techniques, and biliary stricture types (e.g., anastomotic or not), among other potential risk factors.…”

Fully covered metal stents versus plastic stents: The new kid on the block or the old standby?

“…1 The risk factors for the development of ABSs include preceding bile leak, Model for End-Stage Liver Disease score at the time of transplantation, degree of graft steatosis, age, and reperfusion injury. 2 Typically, ABSs are asymptomatic and are usually suspected in the context of cholestatic liver test result abnormalities when alternative causes, such as graft rejection, have been excluded. Imaging tests, particularly MRCP, are useful in establishing a diagnosis of ABS, but ultimately a cholangiogram is generally needed for solidifying a diagnosis and treating the condition.…”