Endoscopic retrograde cholangiography and percutaneous transhepatic cholangiodrainage in biliary strictures after liver transplantation: Long‐term outcome predictors and influence on patient survival

Abstract

Background & Aims: Biliary strictures are common complications after orthotopic liver transplantation. Endoscopic retrograde cholangiography evolved as standard and percutaneous transhepatic cholangiodrainage as alternative therapy. This study analysed predictors of long-term success of biliary strictures after endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage and its impact on patient survival. Methods: All adult patients with biliary strictures receiving endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage between 2009 and 2015 at the University Medical Center Hamburg-Eppendorf were retrospectively analysed. Potential predictors of long-term success (≥12 months) were identified by univariate and logistic regression analyses. Patient survival was analysed by Kaplan-Meier method and log-rank test. Results: Hundred and sixteen patients were treated with endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage, including 67 patients with anastomotic strictures, 22 with nonanastomotic strictures and 27 with both stricture types. Eighty-five patients received endoscopic retrograde cholangiography, 17 percutaneous transhepatic cholangiodrainage and 14 both techniques.Long-term success was achieved in 60 patients (52%). Predictors of treatment failure were a preinterventional C-reactive protein >8 g/dL in anastomotic strictures (P = 0.039) and a body mass index ≤21 kg/m 2 in nonanastomotic strictures (P = 0.021).In patients who received endoscopic retrograde cholangiography only, balloon dilatation of anastomotic strictures with larger diameters favoured success (P = 0.015). Achievement of long-term success was associated with prolonged patient survival inPlatelets (10 3 /µL) 204 (21-658) Alanine aminotransferase (U/L) 73 (12-661) Aspartate aminotransferase (U/L) 54 (14-297) Gamma glutamyl transferase (U/L) 472 (31-3111) Alkaline phosphatase (U/L) 354 (64-2270) Bilirubin (g/dL) 1 (0.2-26) Creatinine (mg/dL) 1 (1-4) C-reactive protein (mg/L) 15 (1-185) International normalised ratio 1 (1-2) Continuous variables are reported as median and range. Categorical variables are provided as counts and percentages. * P < 0.05. ** P < 0.01.

Long-term outcome after living donor liver transplantation compared to donation after brain death in autoimmune liver diseases: Experience from the European Liver Transplant Registry

“…Several studies reported that biliary complications were significantly associated with PSC recurrence risk 18,19 . Biliary complications, including biliary leak and anastomotic and non‐anastomotic strictures, present the most common and challenging problem after LT 20,21 . Complication rates were significantly higher after LDLT than DBD in previous reports 10,11 .…”

PTBD in the Treatment of Biliary Stricture after Liver Transplantation

“…For the high degree of obstructive jaundice, however, PTBD seems to have higher effectiveness than ERCP (7). From the result of long-term prognosis and survival time, the efficacy is only associated with whether it is anastomotic biliary stricture or not (8). As ERCP plastic stents are prone to extrusion, deformation and secondary obstruction or shedding of plastic stent, it is suggested that PTBD has better curative effect than ERCP in biliary obstruction by compression of tumor recurrence.…”