Management issues in post living donor liver transplant biliary strictures

Wadhawan, Manav; Kumar, Ajay

doi:10.4254/wjh.v8.i10.461

Cited by 16 publications

(18 citation statements)

References 57 publications

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“…Biliary stricture complicating living donor liver transplantation (LDLT) is a relatively common complication, occurring in most transplant centres across the world. Improvements in technique, better postoperative care, surgical expertise and immunosuppressive medications have resulted in a decreased incidence of biliary complications over the years[ 1 - 3 ]. The Roux en Y hepaticojejunostomy has given way to duct-to-duct anastomosis (DD) which is the preferred mode of biliary reconstruction in most cases[ 4 - 8 ].…”

Section: Introductionmentioning

confidence: 99%

Biliary strictures complicating living donor liver transplantation: Problems, novel insights and solutions

Rao

Prakash

Sudhindran

et al. 2018

WJG

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Biliary stricture complicating living donor liver transplantation (LDLT) is a relatively common complication, occurring in most transplant centres across the world. Cases of biliary strictures are more common in LDLT than in deceased donor liver transplantation. Endoscopic management is the mainstay for biliary strictures complicating LDLT and includes endoscopic retrograde cholangiography, sphincterotomy and stent placement (with or without balloon dilatation). The efficacy and safety profiles as well as outcomes of endoscopic management of biliary strictures complicating LDLT is an area that needs to be viewed in isolation, owing to its unique set of problems and attending complications; as such, it merits a tailored approach, which is yet to be well established. The diagnostic criteria applied to these strictures are not uniform and are over-reliant on imaging studies showing an anastomotic narrowing. It has to be kept in mind that in the setting of LDLT, a subjective anastomotic narrowing is present in most cases due to a mismatch in ductal diameters. However, whether this narrowing results in a functionally significant narrowing is a question that needs further study. In addition, wide variation in the endotherapy protocols practised in most centres makes it difficult to interpret the results and hampers our understanding of this topic. The outcome definition for endotherapy is also heterogenous and needs to be standardised to allow for comparison of data in this regard and establish a clinical practice guideline. There have been multiple studies in this area in the last 2 years, with novel findings that have provided solutions to some of these issues. This review endeavours to incorporate these new findings into the wider understanding of endotherapy for biliary strictures complicating LDLT, with specific emphasis on diagnosis of strictures in the LDLT setting, endotherapy protocols and outcome definitions. An attempt is made to present the best management options currently available as well as directions for future research in the area.

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Section: Introductionmentioning

confidence: 99%

Biliary strictures complicating living donor liver transplantation: Problems, novel insights and solutions

Rao

Prakash

Sudhindran

et al. 2018

WJG

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“…Besides the intervention itself, some studies have alluded to points in post‐transplant care where biliary stricture patients incur more costs than patients without complications. Evaluation and management of a possible stricture starts with transabdominal ultrasound, progressing potentially to magnetic resonance cholangiopancreatography, then to ERCP or PTC, for patients who fail endoscopic management . Each step in diagnosis and management is associated with additional cost and prolonged hospital stay for patients with biliary complications, all of which contribute to increased spending for transplants through the first post‐transplant year in centers with high rates of BC …”

Section: Discussionmentioning

confidence: 99%

“…Based on the identification of the many variables influencing the development of biliary strictures, much attention has been dedicated to minimizing these risks. Still, biliary complications, and more specifically, strictures, remain major sources of increased expenditure following liver transplant . No studies to date have assessed the cost burden of biliary stricture on the healthcare system.…”

Section: Introductionmentioning

confidence: 99%

A cost analysis of early biliary strictures following orthotopic liver transplantation in the United States

Bhutiani

Jones

Wei

et al. 2018

Clinical Transplantation

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“…There are instances in which the postsurgical anatomy may be difficult for endoscopic treatment. Such instances include a "crane neck deformity" in which the size discrepancy in the CBD of the donor and recipient results in a sharp angulation at the anastomosis [53,54]. When leaks occur in conjunction with strictures, difficulty can arise when attempting to cross the stenosis endoscopically as the guidewire may preferentially slip into the discontinuity [54].…”

Section: Variant 3: Initial Therapeutic Procedures For a Liver Transplmentioning

confidence: 99%

“…These include placement of an internal-external biliary drain with sequential upsizing, stenting via the percutaneous route, and a rendezvous technique. The latter minimizes the need for percutaneous tract dilatation [54,55].…”

Section: Variant 3: Initial Therapeutic Procedures For a Liver Transplmentioning

confidence: 99%

ACR Appropriateness Criteria® Radiologic Management of Biliary Obstruction

Fairchild

Hohenwalter

Gipson

et al. 2019

Journal of the American College of Radiology

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Management issues in post living donor liver transplant biliary strictures

Cited by 16 publications

References 57 publications

Biliary strictures complicating living donor liver transplantation: Problems, novel insights and solutions

Biliary strictures complicating living donor liver transplantation: Problems, novel insights and solutions

A cost analysis of early biliary strictures following orthotopic liver transplantation in the United States

ACR Appropriateness Criteria® Radiologic Management of Biliary Obstruction

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