Association of hepatic artery stenosis and biliary strictures in liver transplant recipients

Abstract

Biliary complications are important causes of morbidity and graft failure in patients after orthotopic liver transplantation. Nonanastomotic biliary strictures (NAS) are frequently the most challenging biliary complications. Hepatic artery stenosis (HAS) as a cause of biliary strictures has not been studied well systematically. We performed a retrospective cohort study of patients who underwent liver transplantation at our institution between 1995 and 2007 to determine the incidence of biliary strictures (nonanastomotic and anastomotic) with HAS. Forty patients were identified, and they were compared with 62 matched non-HAS controls. Overall, NAS and biliary anastomotic strictures were seen more frequently in patients with HAS (24/40 or 60%) versus control patients (6/62 or 9.67%, P < 0.000001). Cholangiographic evidence of NAS was seen in 10 of 40 study patients (25%) and in 1 of 62 control patients (2%, P < 0.0001), whereas evidence of biliary anastomotic strictures was seen in 14 of 40 study patients (35%) and in 5 of 62 control patients (8%, P ¼ 0.0006). The cold ischemia time was also found to be associated with the presence of NAS in patients with HAS (P ¼ 0.024). Patients with biliary strictures were generally managed successfully with endoscopic retrograde cholangiopancreatography balloon dilation/stenting, except for 4 NAS patients who had significant morbidity and mortality. In conclusion, the development of HAS, particularly with a prolonged cold ischemia time, may increase the NAS risk after liver transplantation. HAS is also associated with the development of biliary anastomotic strictures. Prospective studies of frequent arterial monitoring for the early detection of HAS and interventions to prevent biliary complications are needed.

Endoscopic management of biliary strictures after living donor liver transplantation

“…Hepatic artery thrombosis or stenosis is considered an important risk factor for non-BAS [36]. Immunological factors (e.g., ABO blood type incompatibility [37,38] and cytomegalovirus infection [39]) are also associated with non-BAS formation.…”

Early Biliary complications after liver transplantation

“…Factors associated with the development of early and late NASs are included in Table . Acute HAT/stenosis and biliary reconstruction type have also been documented as risk factors for both early ASs and NASs, with strictures reported in some series to be more common after Roux‐en‐Y choledochojejunostomy compared with duct‐to‐duct choledochocholedochostomy …”

Interventional radiology in the management of the liver transplant patient

“…Patients with HAS typically present with graft dysfunction or biliary complications, but a stenosis may be subclinical in up to 20% of patients, which emphasizes the importance of close laboratory and imaging surveillance . Additionally, early diagnosis of HAS is critical because delay has been shown to increase the severity of biliary complications and the chance of graft loss …”