Biliary Strictures Are Associated With Both Early and Late Hepatic Artery Stenosis

Abstract

Background. Hepatic artery stenosis (HAS) following liver transplantation results in hypoperfusion and ischemic damage to the biliary tree. This study aimed to investigate how vascular intervention, liver function test derangement, and time point of HAS onset influence biliary complications. Methods. A single-center retrospective study of adult patients that underwent primary liver transplantation. Patients were grouped according to the presence or absence of HAS and then into early (≤90 d) or late (>90 d) subgroups. Biliary complications comprised anastomotic (AS) or non ASs (NASs). Results. Computed tomography angiography confirmed HAS was present in 39 of 1232 patients (3.2%). This occurred at ≤90 and >90 days in 20 (1.6%) and 19 (1.5%), respectively. The incidence of biliary strictures (BSs) in the group with HAS was higher than the group without (13/39; 33% versus 85/1193; 7.1%, P = 0.01). BS occurred in 8/20 (40.0%) and 5/19 (26.3%) of the early and late groups, respectively. The need for biliary intervention increased if any liver function test result was ≥3× upper limit of normal (P = 0.019). Conclusions. BS occurs at a significantly higher rate in the presence of HAS. Onset of HAS at ≤90 or ≥90 days can both be associated with morbidity. Significant liver function test derangement at HAS diagnosis indicates a higher likelihood of biliary intervention for strictures.

Reconstruction of all hepatic arteries in right lobe grafts with 2 hepatic arteries and zero percent hepatic artery thrombosis

“…Biliary stricture is a related complication resulting from HA ischemia 9 . According to our data, after a HAT event, biliary stricture occurred in ~half of the patients (11/20, 55%), and further procedures such as endoscopic retrograde cholangiopancreatography or percutaneous transhepatic bile drainage were performed.…”

Biliary complications after adult to adult right-lobe living donor liver transplantation (A-ARLLDLT): Analysis of 245 cases during 16 years period at a single high centre- A retrospective cohort study

“…We found an independent correlation between Post LT HAT/S and overall BCs, strictures and leaks; similarly, arterial complications were independent predictors of BCs in Reyes et al, 2020 [ 10 ] study, and HAT/S was a significant predictor of biliary stricture in Gunawansa et al, 2011 [ 25 ] study. Also, there was a significant association between HAS and biliary stricture in Hann et al, 2020 [ 55 ] study. Conversely, HAT was not associated with biliary stricture in Na et al, 2014( 48) study, and HA complications were not predictors of BCs in Ogiso et al, 2020 [ 19 ] study.…”

Post-Transplant Biliary Strictures: An Updated Review

“…The American Association for the Study of Liver Diseases defines early NAS as occurring within the first year after LT, but other studies have used a cutoff of 90 or 180 days. 8,9,12,13 The incidence of NAS varies in different series from 1 to 19%. 14,15 NAS typically presents at a median of 3 to 6 months post-LT, with over 50% occurring within the first year.…”