Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation

Abstract

19 patients (3.7%). Long-term success was observed in 77% of patients with AS. In patients with NAS, partial long-term responses could be achieved in 63% of patients. Five patients (6.2%) required a percutaneous and 6 (7.4%) patients a surgical approach.In conclusion, the long-term outcome for patients with post-liver transplant biliary strictures after endoscopic treatment is excellent, especially for patients with AS. Development of NAS reduces graft but not patient survival after endoscopic therapy. Liver Transpl 12:718-725, 2006.

Barking up the wrong tree: MicroRNAs in bile as markers for biliary complications

“…3 Donation after circulatory death (DCD) has been identified as a major risk factor for the development of ITBL in recipients, with the incidence rising up to 30%. 2 It is thought that the prolonged period of warm ischemia in DCD underlies the unrepairable injury to the biliary tree that predisposes patients to ITBL.…”

Endoscopic Management of Biliary Complications After Liver Transplantation

“…The incidence is greatest in the first 5 to 8 months (range, 1 to 36 months) (Gondolesi et al, 2004;Yazumi & Chiba, 2005;Kasahara et al, 2006). Recently, it has been suggested that prevalence continues to increase with time after transplantation , and that NAS presents earlier than AS, with mean time 3.3-5.9 months (Graziadei et al, 2006;Guichelaar et al, 2003). Moreover, NAS secondary to ischemic causes was shown to present within 1 year of the transplant, whereas the occurrence after 1 year was more often secondary to immunological causes .…”

“…Hepatic angiography may be indicated if hepatic vascular abnormality was suspected (Thuluvath et al, 2005). US may have low sensitivity (close to 50%) to detect biliary dilatation in patients who received transplantation (Graziadei et al, 2006;Zoepf et al, 2005) and not accurate enough to diagnose or localize biliary strictures either because the true diameter of cast filled bile ducts could not be properly determined, acute obstruction may not result in a prompt dilatation of the prestenotic bile ducts (Zoepf et al, 2005) or because dilatation of the biliary system in allografts may develop slower (Shastri et al, 2007). Different studies reported variable results for helical computed tomography and magnetic resonance imaging.…”

“…ERC is considered as the gold standard, most physiological, least invasive diagnostic and therapeutic interventional option that carries good long term results in terms of graft and patient survival. ERC has an overall success rate in the range of 70%-100% in deceased donor liver transplantation (DDLT) (Graziadei et al, 2006;Morelli et al, 2003;Thuluvath et al, 2005;Williams & Draganov, 2009) and 60-75% in living donor liver transplantation (LDLT) Tsujino et al, 2006;. Percutaneous transhepatic cholangiography (PTC), although it has high success rate (50%-75%), is most often spared as a second line option for patients with Roux-en-Y bilioenteric reconstruction or failed ERC; and this is because the possible associated morbidities of PTC like hemorrhage and bile leak ( (Sharma et al, 2008;Williams & Draganov, 2009).…”

“…Surgical revision in the form of Rouxen-Y bilio-enteric reconstruction is usually the operation of choice in patients with duct-toduct anastomosis. In those who already have a Roux-en-Y bilioenteric anastomosis, repositioning the graft bile duct to a better vascularized area may be required , while retransplantation could be the last resort when all else fail (Graziadei et al, 2006;Williams & Draganov, 2009). …”